Learning Network QI Project Updates

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2012 NYS HIV Quality of Care Program

Quality Improvement Project Focus

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Adolescent Quality Learning Network-VL Suppression & Transitioning Care

Substance Use Learning Network-VL Suppression

Community Health Center QLN-VL Suppression & Retention

HHC QLN-Linkage to care, retention & VL suppression

Secondary Drivers

Primary Outcome Primary Drivers

Increase the viral load suppression

rate by 10% across clinics over a 10

month period

Retention

Psycho-Social

Support

ARV Adherence

Substance Use

Mental Health

Appointments

Transportation

Continuity of care

Treatment Education

Health Literacy

Health Insurance

Housing

Staff attitude

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Network Viral Load Suppression QI Project9/7/12

Dan Belanger TeamIHI IA Score: 3.5

Predicted Score by 12/31/12: 4.1

2012 Community Health Center Quality Learning Network Viral Load Suppression QI Project

Community Health Center Quality Learning Network HIV Viral Load Suppression QI Project

Improve the VL Suppression rate by 10% across 7

community health centers by

12/31/12

Psycho-Social

Support

Retention

ARV Adherence

Clinic system/processes

Clarity of purpose-goals, roles, responsibilities

Clinic QM infrastructure

Clinic environment

Staff communication

Clinic flow

Treatment education

Health literacy

Health insurance

Self efficacy

consumer involveme

nt

Housing

Substance Use

Mental Health

Case management/

SW Support

Patient support network

Appointments

Transportation

Continuity of care

Staff attitude

Staff/patient communication

Site – Cohort 1 patients

# whose most recent VL during the Jan-March period is >200#initiated with QI intervention as of 4/1/2012

# with a successful intervention

# who received a post-initiation viral load test

# who are suppressed

GHV – 8 patients

IFH – 47 patients

OD – 9 patients

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% of unsuppressed patients who received a QI intervention before 4/1/12 and a most recent viral load test since with a suppressed viral load test result

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QI Interventions Tested

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Addressed adherence at medical and Mental Health appointments

one-on-one educationchecklist of intervention itemspatient questionnairecase conferenceIncreased adherence counselingDOTViral Load Visualsteach backphone call adherence counselingincreasing clinic attendance (every 4-6 weeks)

Shewhart Chart Exercise: Providers agreed to begin to investigate using Shewhart Charts for QIA follow up webinar will be scheduled in July

Clinic Five

Clinic Five was well known for using incentives to improve various aspects of care. They had never incentivized adherence to ARV treatment regimen, however, until doing an eHIVQUAL review, and seeing that the viral load suppression rate was less than 40% clinic wide. They came up with a plan, broadly advertising incentives for adherence measured by a suppressed viral load. All patients with a suppressed viral load at their next visit would get a $50.00 gift card from a major credit card company that could be used almost anywhere to buy almost anything. They noticed a major increase in the viral load suppression rate. Unfortunately the gift cards were a one-time donation from the credit card company, so the incentives were not sustainable and neither was the increase in the viral load suppression rate. They believe the data showed that the incentives showed an improvement based on the data. Do you agree?

If you agree, please circle the area on the chart where the “special cause” occurred, showing significant improvement, and based on this background information annotate the chart. What is the rule that proves that this change is due to a special cause rather than a common cause?9

Next Steps

A webinar to further discuss understanding variation over time through the use of the Shewwhart chart will be scheduled

We will share QI project outcomes such as the rate of unsuppressed patients involved in QI interventions across clinics

We will also share with providers viral load suppression rates Sharing aggregate data on PDSA cycles with providers Co-facilitate analysis of data from tests

In addition we will share with providers results from other learning networks involved in QI activities to improve viral load suppression

We will assist providers in negotiating challenges

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Thanks to Leah Savitsky Andrew Lai Wei Miranda RosenbergChris ReisigClaire McCullough Johanna BuckDarryl NgRon MoenClemens Steinbock, IA MentorBruce Agins. IA Sponsor

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And…Beth BonacciJoAnn BeasleyFAYS Team

Marc SliferJanice BiglerSU Section

Terry HamiltonJudy YanEunice CaseyHHC Team12