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




Every year, NQC solicits applications from Ryan White grantees for our annual Quality of Care Awards. With each passing year it becomes more obvious that so many Ryan White grantees have made a tremendous commitment to quality improvement. Reading the applications gives one a tangible sense of the pride grantees have as they narrate their improvement successes.


Each year, the review committee has a difficult task in choosing winning applications because in reality, every application has merit, shows an incredible sophistication and proves that the real winners are the clients who benefit from these efforts. NQC salutes all the applicants and encourages grantees of all Parts to apply for an Award next year and be recognized for your efforts as well.


Our personal congratulations to our winners! 


Clemens Steinbock

Director, National Quality Center


> In This Issue

> NQC News | 2013 Quality Award Winners!
> NQC News | New HAB/NQC Collaborative Focuses on Retention in HIV Care and Viral Load Suppression
> NQC News |...in+care Campaign Update
> Consumer Perspective | Patsy Lawson
> Quality Corner | Wake Forest Baptist Medical Center
> Quality Tip of the Month | Quality "Games"
> HAB Webinar | Changes to the HAB Performance Measures
> National TA Call | Managing Quality Efforts Across a Network of Providers

> NQC News | 2013 Quality Award Winners!


Congratulations to this year's winners and thanks to all who submitted nominations!


Award for Quality Improvement Activities: Ponce Part A Transitional Grant Area (TGA)

The Quality Management Program of Ponce's Part A Program initiated a PDSA cycle in 2012 to improve the Pap smear performance rate. In 2011, 50 percent of women receiving services from subgrantees receive a Pap smear. The quality management committee set a goal of 52 percent in Pap smear compliance and initially identified barriers. These barriers included patients' perception and beliefs about gynecological care, access to Pap smears under government health plan coverage, limited communication between HIV primary care providers and gynecological service providers, and limited clinical staff trained in providing Pap smears. A consumer representative also provided input about cultural barriers and access to care.


Based on the findings, the committee developed an improvement plan that included patient education, staff training, hiring of a nurse to conduct the screenings, and the establishment of a cooperative agreement for the processing of the tests. As a result of these changes, Pap smear compliance rose to 72 percent, an increase of over 20 percent.


Award for Leadership in Quality: Patricia High, Ocean County Health Department

Patricia High is the Supervising Program Analyst for the Ryan White Part B HIV/AIDS Care and Treatment Clinic of the Ocean County Health Department (OCHD) in New Jersey. In 2012, Patty initiated a continuous quality improvement program that involved program staff, consulting clinicians, consumers, and community-based programs. With staff and community buy-in, Patty developed pilot initiatives based on the Plan, Do, Act, Study (PDSA) Cycle to improve measures related to viral load suppression, serologic testing, and hepatitis B virus vaccination among other pertinent measures of care.


One area of focus was on increasing the number of clients with an undetectable viral load. She worked with program staff to decrease treatment gaps by improving treatment adherence counseling, access to AIDS Drug Assistance Program (ADAP), the pharmaceutical delivery system, and client nutrition. Data were collected during 2007-08 revealed that the virla load suppression rate was 58%. This was a marked increase from previous years but still not acceptable. By the 2012-13 grant year, the rate of viral suppression was 83 percent, reaching as high as 88 percent in some reporting cycles. Another area of focus was increasing rates of serologic testing by removing obstacles to receiving these services. Clients whose insurance failed to cover the tests requested were offered the opportunity to receive no-cost testing directly at the OCHD. Additionally, for those clients who had difficulty scheduling an appointment with a physician and to obtain a lab slip, lab slips were mailed directly to the client to allow for serologic testing at their convenience. As a result, improvements have been seen in testing for Chlamydia/Gonorrhea, hepatitis B virus, hepatitis C virus, toxoplasmosis, and tuberculosis.



Learn more l nationalqualitycenter.org/awards

> NQC News | New HAB/NQC Collaborative Focuses on Retention in HIV Care and Viral Load Suppression


The HAB/NQC HIV Cross-Part Care Continuum Collaborative (H4C) is an important, new national initiative that is facilitated by NQC. It is designed to apply the Collaborative Model to a multi-state effort to improve viral load suppression rates and other areas of the HIV Care Continuum.


H4C will engage grantees from all Ryan White Part funding sources in the selected states. The states will benefit from a regional team structure focusing on viral load suppression and the strengthening of a quality infrastructure built to sustain efforts beyond the formal HAB/NQC sponsorship of the Collaborative. It is the aim of this national quality initiative not only to improve viral load suppression rates but also to potentially impact other components of the Care Continuum.


The specific aims of H4C are:

  • Build regional capacity for closing gaps across the HIV Care Continuum to ultimately increase viral load suppression rates for individuals living with HIV.
  • Align quality management goals across all Ryan White HIV/AIDS Program Parts to jointly meet the legislative quality management mandates.
  • Implement joint quality improvement activities to advance the quality of care for people living with HIV within a region and to coordinate HIV services seamlessly across Parts.

Stay tuned for more information and lessons learned as the state teams work to address retention in care and viral load suppression in their regions.


Learn more about this upcoming Collaborative | click here

 > NQC News | in+care Campaign Update


As our participants know, the in+care Campaign is focused on retaining people with HIV in health care. In particular, patients new to care are vulnerable and need special attention to ensure that they are retained in care. This will be the Campaign's population of focus for the month of October. Research has shown that people who are not linked to and retained in care within the first year of their diagnoses are far less likely to engage in health care in time to avoid unnecessary adverse consequences. The in+care Campaign has collected a number of strategies from participating sites regarding this population, which will be shared in upcoming webinars.


What's Next?

The Campaign's active phase will be transitioning to a sustaining phase as of January 1, 2014. This means that the Campaign's newsletters and webinars will slow down, but you'll still be able to submit your retention performance data online to the in+care Campaign database for the foreseeable future.


In addition, news and important content related to the in+care Campaign will be shared and disseminated through the NQC e-Newsletter and the ongoing monthly NQC TA calls. Much of the content shared starting in January 2014 will focus on results and feature community providers that have kept Campaign staff up to date on the retention improvement strategies they have put in place at their agencies.


Learn more about the in+care Campaign | click here

> Consumer Perspective: Patsy Lawson


After putting in 13 years as a volunteer at the Los Angeles Family AIDS Network, Patsy Lawson was a seasoned veteran. She was active on the community advisory board, participated in evaluation activities, took part in educational forums, and helped to organized clothing drives and other support activities. Then, she was named to the Los Angeles County Commission on HIV in July, where she will serve on the Standards and Best Practices Committee. This took her involvement to a whole new level.


Just months before she was named to the Commission, Patsy participated in NQC's Training of Consumers for Quality. The training is designed to increase the number of consumers actively participating in local quality management committees and regional quality improvement activities.


"Everything I learned at the training will help me," says Patsy. "Especially how to collect and analyze data and how to look at problems using PDSA cycles."


In addition to learning how to use quality improvement tools, the training provided participants with the expertise to determine when to use specific tools.


"We learned to look at the data and the preliminary results when doing PDSA cycles," says Patsy. "If your findings are inconclusive, it is better to move on to other issues that may be more important in terms of improving care."


Not only did the training provide concrete tools to participants, it also stressed the development of skills they will need to be effective advocates.


"It was reassuring. It gave me an opportunity to get used to people looking at me while I was speaking," says Patsy. "I left thinking that this is something I can do."


While she will bring her expertise and experience to the Commission, Patsy is also determined to bring another message.


"I want to provide insight into the African American community," she says. "We have often been a silent voice in this fight. We need to take leadership roles and stand up and be counted."


Patsy wasn't the only new member named to the Commission in July. Her daughter has also been named a Commissioner and attended the NQC's Training of Consumers on Quality.



"Seeing what she is doing makes me feel like I did something right," says Patsy. "I have given her the tools and now she is walking the walk."

> NQC e-Newsletter | Volume 7 | Issue 64 | Oct 2013 


Quick Links


> Upcoming Events | October - November

October 8, 2013 | 1pm ET

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


October 17 | National TA Call | Working with Subcontractors Across a Network


October 23 | HAB Webinar | Changes to HAB Measures


November 2 - 6 | American Public Health Association Annual Meeting


November 12 | in+care webinar | Retaining Transgender Individuals In Care

> Quality Corner | Wake Forest Baptist Medical Center


The Wake Forest Baptist Medical Center (WFBMC) in Winston-Salem, North Carolina is a Part B, C, and D grantee. In addition, WFBMC participates in NC LINK, which is part of the multistate SPNS Systems Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative. Since it is also participating in the in+care Campaign, retention and re-engagement are very much on WFMBC's radar screen. To address this challenge WFMBC carefully reviewed their own data and processes and reached out to other providers in the state in an effort to re-engaged patients that had been lost to care.


WFBMC is a large provider, serving approximately 2,000 patients drawn from a multi-county service area. Many newly diagnosed patients gravitate to WFMBC but staff members also have observed that they lose a significant number of patients over time. To explore what happens to these patients, WFBMC implemented PDSA cycles for retention interventions as part of the NC LINK project. The first step was to generate a list of patients that had not been seen in 2 or more years but were still listed as active in CAREWare. Each patient was carefully researched and the results indicated that most of these patients were no longer receiving care with WFMBC-the vast majority of these due to death, relocation, or incarceration.


Once the inactive patients were removed from the system, a list of patients out of care for more than 9 months was developed. The first cycle generated a list of 70 patients targeted for outreach, which is conducted by patient navigators via phone calls, letters, Internet searches, etc. Once located, the navigators work with patients to address issues, such as transportation or unstable housing, which may be creating challenges to accessing care. Transportation has been identified as the most significant barrier to retention. The navigators also engage in extensive patient education-bridge counseling-that emphasizes the importance of remaining in care.


Since this intervention has been implemented, 436 patients have been target for outreach. Forty-two (42) percent of these hard-to-reach patients have been re-engaged in care at WFBMC. Twenty-seven (27) percent have been assigned a definitive case outcome (relocation, long-term incarceration, or death). The remaining 31 percent of patients were referred to the state health department for more extensive case finding efforts. Of these, 22 percent have been assigned a definitive outcome thus far, including 13 percent linked back to care at WFBMC.


While there are four patient navigators dedicated to bridge counseling, the emphasis on re-engagement has had an impact across staff and the entire patient population.


"The bridge counseling process is sending a message to both staff and patients," says Jennifer Keller, WFBMC's Clinical Quality Administrator. "Our staff is now consistently delivering the message to patients that remaining in care is essential to their well being. On a monthly basis, we now see more patients retained in care."

> Quality Tip of the Month | Quality "Games" 


Quality games aren't really games at all; they are more like entertaining learning opportunities that involve multiple team members. You have heard NQC talk many times about how teams outperform individuals when a task is complex. Creativity is needed and fast solutions need to be found. If you have ever attended an NQC face-to-face training, you have played the Stranded on the Moon, Red Bead or Peanut Butter and Jelly games to name but a few. Games present a "learn by doing" opportunity that engages participants in learning quality improvement principles and are a valuable teaching tool.


Get the NQC Game Guide | click here.

HAB Webinar | Changes to the HAB Performance Measures


The HIV/AIDS Bureau will host a webinar on Wednesday, October 23, 2013 from 2-3pm EST to present and review the changes to the HIV/AIDS Bureau performance measure portfolio. This webinar follows two webinars held in June 2013 to collect feedback from stakeholders on the proposed changes to the performance measures. There is no registration for this session.


To access the webinar: https://hrsa.connectsolutions.com/perfmeasport/

To access the audio portion: 800-369-3319 Participant passcode: 7181956#

> National TA Call: Managing Quality Efforts Across a Network of Providers


Many grantees have a network of providers that help them deliver Ryan White Program services to clients. Grantees are required to conduct quality improvement activities and that includes QI activities with their subgrantees.   This month's call will focus on how that is done by grantees funded under different Parts of the Ryan White Program. The call will consist of a series of presentations by grantees on how they have accomplished this as well as strategies to assist you in your QI effort.



National TA Call

October 17, 3:00-4:30 pm ET

Access the Webinar | Click here

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

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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