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NQC e-Newsletter |  Your expert guide to resources and technical assistance focusing on improving HIV care.




Our NQC e-Newsletter has a few new features. Our grantee focus is now on quality improvement projects that grantees have successfully conducted and in addition, we provide a quality tip of the month. Our goal is to keep the focus on improvement and to offer you solid tools and suggestions as you conduct your improvement efforts. We strongly encourage grantees to send us in their quality tips since we want to share them with your peers.


This month's feature article concerns how NQC manages its own improvement projects, using the same quality improvement methodologies used by Ryan White grantees. Normally our improvement activities are conducted behind the scenes but NQC and the HIV/AIDS Bureau agreed that we should develop a storyboard around our improvement project. The results will be posted this month to our website so keep an eye out how the improvers improve.

Hopefully, you have all enjoyed the summer and had a wonderful Labor Day.


Clemens Steinbock

Director, National Quality Center


> In This Issue

> NQC News | Improving the Processing of TA Requests: We Are Here For You
> NQC News | in+care Campaign Update
> Consumer Perspective | Jace Dyckman
> Quality Corner | The FXB Center Focuses on Retention of Young Patients
> Quality Tip of the Month | PDSAs: Making the First Step Count
> National TA Call | Change Fatigue

> NQC News | Improving the Processing of TA Requests: We Are Here For You!


Every day, NQC works with Ryan White grantees to help them improve the services they provide. But quality improvement is not just for grantees. NQC also applies quality improvement concepts to our own work. For example, a recent NQC project explored the length of time it takes NQC to respond to technical assistance (TA) requests in order to assess how responsive we are to these requests. NQC adopted a new measure for the project-the number of days it takes to respond to a TA request. It examines our responsiveness to grantees' requests.


After analyzing the data, NQC found that the procedure to respond to TA requests were, for the most part, reliable and responsive. During the study period of 2 months, NQC received 18 requests for technical assistance. Over all, NQC responded to 16 of the 18 requests within 2 business days. Internal errors accounted for the 2 TA requests that were not responded to within 2 days. This indicated the need to make adjustments to the way information is delivered to NQC in order to ensure it made its way to the NQC staff responsible for TA requests.


In response, NQC is in the process of revisiting the TA request process. The TA request form will soon be available in Adobe PDF format which will allow grantees to enter their information directly into the PDF form. The information can then be saved by the requestor and emailed to NQC. NQC has also set up an auto response for its email so that grantees know that the request has been received and is being processed. Contact information is included in the auto response so grantees can contact us directly if need be.


NQC is dedicated to the timely response to TA requests. If you do not hear back from us, please let us know! Kevin@NationalQualityCenter.org

> NQC News | in+care Campaign Update


The in+care Campaign is approaching its second birthday! To date, the Campaign has enrolled more than 700 people representing over 500 HIV organizations in 48 states and territories serving 470 thousand patients (not unduplicated). In addition, Partners in+care has enrolled more than 650 people with HIV and their allies to join the national dialogue on retention in HIV care.


During September 2013, the in+care Campaign will focus on women and the issues specific to their retention in HIV care. Stay tuned for announcements on upcoming webinars related to this topic. 


Past Webinars: Patient Navigation

The Campaign's recent focus on patient navigation attracted a great deal of attention. More than 120 people joined the August 6th Journal Club featuring the New York City Department of Health and Mental Hygiene and more than 100 people joined the August 8th Campaign webinar that explored three types of patient navigation programs funded by SPNS (peer navigation, nurse navigation, and social worker navigation). 

  • Listen to a recording for the August 6th journal club | Click here
  • View the August 8th webinar | Click here 

Contact Michael@NationalQualityCenter with any questions or for additional resources on patient navigation as a method to improve patient retention in HIV care.


Sharing Performance Data

Over the course of the in+care Campaign, the performance data results have been shared with the Ryan White community. In addition, NQC has collected 375 strategies from Campaign participants so far.


To guide the analysis process and dialogue, the Campaign is relying on the International Association of Providers in AIDS Care (IAPAC) Guidelines for Improving Entry into and Retention in Care and Antiretroviral Adherence for Persons with HIV. To help organize these reported strategies, the Campaign has identified six intervention clusters:

  1. Entry Into and Retention in HIV Care (systematic monitoring of successful entry into HIV care, systematic monitoring of retention in HIV care, brief strength- based case management for newly diagnosed individuals, intensive outreach for individuals not engaged in care, and use of peer navigation services)
  2. Education and Counseling Interventions (offering peer supports)
  3. Health System and Service Delivery Interventions (interventions providing case management services and resources to address food insecurity, housing, and transportation needs)
  4. Substance Use Disorders (offering buprenorphine or methadone to opioid-dependent patients, Directly Administered Anti Retroviral Therapy (DAART) for individuals with substance use disorders, and integration of DAART into methadone maintenance treatment)
  5. Children and Adolescents (intensive youth-focused case management is recommended for adolescents and young adults)
  6. Non-IAPAC Strategies (case conferencing, consistent messaging, patient experience evaluation, and reminder calls) 

Stay tuned for more information on each type of intervention including and the degree to which they have achieved successes.

> Consumer Perspective: Jace Dyckman


Who knew the long Montana winters are conducive to quality improvement activities? Jace Dyckman is a prevention health specialist at RiverStone Health in Billings, Montana. After Jace honed his skills at NQC's Training of Consumers on Quality (TCQ) this past June in Sacramento, CA his supervisor told him that she had several quality-related projects in mind for him to work on once the weather turns cold.


"While we are already conducting many quality-related activities, we know that there is so much more we can do with our CAREWare data," says Jace. "We will be looking at ways to use our data to better explore clients' needs."


But until then, Jace is kept busy with many other responsibilities. In addition to conducting HIV testing and prevention education for RiverStone, Jace works with other consumers to support retention in care and adherence to treatment. Jace helps link consumers to critical support services such as housing or transitional support for incarcerated individuals living with HIV, which in turn, can help consumers remain in care.


"Now that people with HIV are living longer, it is important to let consumers know that they can have a very high quality of life," says Jace. "My role is to educate them that they have control over the quality of the care they receive."


Building skills is just one of the important goals of the TCQ. It also serves to provide a network for consumers involved in quality-related activities.


"Given the rural nature of Montana, I don't really have the opportunity to meet with other consumer advocates and share ideas," says Jace. "At the training it was great to sit around a table with other motivated consumers who are involved in their own care and the improvement of services."


Jace intends to maintain the connections he made at the TCQ through other NQC activities. He is already taking advantage of NQC's Glasscubes, which are online forums that allow users to share their quality improvement resources and discuss quality projects.

> NQC e-Newsletter | Volume 7 | Issue 63 | Sep 2013 


Quick Links


> Upcoming Events | September - October

Thursday, September 19, 2013 |  TA Call | Change Fatigue


Wednesday, September 25, 2013 | 1pm ET

in+care Campaign Webinar | Migrant Clinicians' Network: Focus on Retention for Migrant Populations


Thursday, September 26, 2013 | 3pm ET

in+care Campaign Webinar | Christie's Place: Focus on Women and Retention


Tuesday, October 8, 2013 | 1pm ET

Partners in+care Webinar | Women's Positive Network Explores Retention from a Positive Female Perspective

>Quality Corner | The FXB Center Focuses on Retention of Adolescent Patients


Stability is not a word often associated with the tumultuous teenaged years but the FXB Center in New Jersey strives to provide a stable care experience to its adolescent consumers. To ensure stability, the Center has needed to evolve the way it provides services.


The Center serves about 140 adolescent (ages 13-24) consumers. Many of these young people have been receiving care from the Center their entire life.


"They have been in our care since they were infants so they are comfortable with the environment," says Peter Oates, Director of Health Care Services. "That combined with our very stable staff means that trust has been built over time."


The Center's care model has evolved to support retention in care. The interdisciplinary model places a strong emphasis on case management. Social workers and medical case managers maintain close contact with consumers-making reminder calls (or texts, as many adolescents prefer) and maintaining contact with consumers between appointments. The model is also designed to accommodate adolescents' busy schedules. There is flexible scheduling for appointments and walk-ins are allowed. In addition, the Center has worked to make the clinic more welcoming to adolescents. As its client population aged, an adolescent center with computers, books, and magazines was added to complement the existing play room.


In July 2013, the Center began offering onsite mental health services twice a week. Plans are in the works to conduct a quality improvement project that will track the impact of mental health services on retention in care.


"As our consumers age, mental health issues are bubbling to the surface," says Peter. "We estimate that as many as 70% of our consumers have mental health issues. By addressing these issues, we hope to improve outcomes over time."


The Center works to make the transition to adult care as smooth as possible. Providers such as Peter, who also collaborates with the providers in the adult clinic, come to the clinic for appointments with young patients. The patients also continue to receive services from the same medical case managers and social workers. When they are comfortable, the young consumers can move over to the adult clinic with continued case management support from the Center's staff.


"This gradual approach lessens the fear related to a new care environment," says Peter. "We have tried other approaches but keeping them in a familiar clinic environment really works."


Using data to track the effectiveness of their efforts is deeply engrained in the Clinic's activities. The Clinic participated in NQC's Cross-Part Collaborative Project with other Ryan White providers in New Jersey. It is also participating in the in+care Campaign.


"The in+care Campaign was a natural progression from the collaborative," says Peter. "It is great for us to get feedback on our services and look at where we are-we can compare ourselves to others at the agency, state, and national level. Also, the Campaign is a great forum for sharing best practices and discussing mutual problems."

> Quality Tip of the Month | PDSAs: Making the First Step Count


Clarifying exactly what you want to test is key to the success of a Plan-Do-Study-Act (PDSA) Cycle. Formulating an improvement idea and the change needed to the system to implement the idea is an important first step.  This will give you a basis on which to measure the actual result and to see if your improvement idea has merit. In the planning process, always consider who needs to be involved in the PDSA, the length of the test, and the other factors that will play an important part of the improvement project.


Need to brush up on PDSA Cycles?  The NQC has the tools and resources to help you.


Quality Academy: Tutorial 13, The PDSA Cycle or How Can We Accelerate Improvements in HIV Care

This module focuses on how to use the PDSA Cycle in HIV programs. It provides examples and tips for success.  Click here to access.  


HIVQUAL Workbook (2006). New York State Department of Health AIDS Institute (publication # 9385); pp. 116-126.  Click here to access. 

> National TA Call | Change Fatigue

Due to technical difficulties, our August TA Call had to be cancelled. NQC deeply regrets any inconvenience to those who registered for this call and tried to attend. NQC has taken steps to ensure that it does not happen again.


In order to streamline the registration process, NQC is providing a direct link to the webinar. This will eliminate the two step process in registering and you will no longer need a password. You can simply click guest and type your name and you will be brought into the webinar room. It is hoped that this will simplify your webinar access and enhance your experience. Please give us your feedback on this! It's important to NQC's improvement efforts to know how you perceive this latest change.


We are very pleased to announce that the call will again be given on September 19, 2013 by NQC expert consultant Dr. Ginna Crowe. Do you want to include the description?


National TA Call

September 19, 3:00-4:30 pm ET

Access the Webinar | http://www.nqcqualityacademy.org/tawebinar/

To access the audio portion, dial 866-394-2346 and passcode 3971546368


Previous Technical Assistance Calls:

Gaining Agency and Subcontractor Buy-in for Quality Management, November 2010 | Click here


Engaging Provider Staff and Consumers in Quality Improvement, September/October 2007

Click here


Quality Academy Tutorial 16: Managing Resistance to Change and Holding Gains

This NQC Quality Academy Tutorial deals with the topic of resistance to change. It examines why people resist change and outlines some general approaches to help organizations make changes more easily. Specific strategies to use when your organization encounters direct resistance to new ideas are provided. Click here

National Quality Center

New York State Department of Health

AIDS Institute

90 Church Street, 13th floor

New York, NY 10007-2919

Phone | 212.417.4730

Fax | 212.417.4684

Email | Info@NationalQualityCenter.org 


Sharing, Training, Consulting.

Improving HIV Care.

> About Us


We provide no-cost, state-of-the-art technical assistance to all Ryan White Program-funded grantees to improve the quality of HIV care nationwide.  


Send questions, comments, or suggestions | Info@NationalQualityCenter.org  


This e-Newsletter is produced by the National Quality Center, a quality improvement initiative funded through a cooperative agreement with the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau. For more information | NationalQualityCenter.org  


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