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




As we head toward 2014, I wanted to reflect on NQC's work with all our grantees. The in+care Campaign provided support for the goals of the National HIV/AIDS Strategy. Hundreds of grantees from around the country participated and used performance data to make tremendous strides in retentaining individuals in ongoing HIV care. Our National TA Calls provided new topics and thoughtful insights from experts in the field of quality improvement. New Regional Groups formed around the country to promote peer networking and learning. Most recently, NQC launched a new collaborative and invited 6 states and all their Ryan White grantees to actively participate. These activities benefited Ryan White programs and the consumers they serve.


On behalf of the NQC staff, it has been a privilege to work with all of you and assist you in advancing the principles and practice of quality improvement.


Our sincere best wishes to all for a healthy and happy holiday season and a joyous New Year.




Clemens Steinbock

Director, National Quality Center


> In This Issue

> NQC News | NQC's Consumer Advisory Committee Now Recruiting New Members
> NQC News | in+care Campaign
> Quality Corner | Gurabo Community Health Center
> NQC Training | TOT and TQL in 2014
> Consumer Perspective | Angel Hernandez
> Quality Tip of the Month | A Brief Word about Data
> National TA Call | Back to Basics - Quality 101

> NQC News | NQC's Consumer Advisory Committee Now Recruiting New Members


Help the NQC improve the quality of HIV care. The National Quality Center (NQC) is recruiting new members for its Consumer Advisory Committee (CAC).


Participatory involvement by people living with and affected by HIV is an integral component of the NQC. Through the NQC Consumer Advisory Committee (CAC), HIV-infected and affected consumers assist the NQC to develop and refine initiatives to improve the quality of HIV care across the country and, in particular, services provided through the Ryan White Program. The goals for the CAC are to:

  • Provide feedback on NQC services and their impact on the quality of HIV care;
  • Provide recommendations to NQC staff on the development and implementation of existing or new portfolio of activities from the consumer perspective; and
  • Inform community members about NQC services and consumer activities. 

The Committee is made up of 10 appointed persons living with HIV/AIDS (PLWHA) from across the country, representing the various Department of Health and Human Services regions.


CAC Member Eligibility Criteria - To participate in the NQC CAC you should possess:

  • A strong understanding of HIV quality management program infrastructure that exists across currently funded Ryan White programs.
  • Be actively engaged in quality improvement activities within a Ryan White grantee.
  • Knowledge of NQC portfolio and program initiatives.
  • Be able to commit time to regularly participate in routinely scheduled CAC workgroup conference calls to provide meaningful recommendations to NQC staff on existing or new portfolio of activities.
  • The desire to participate in a Ryan White Regional Group or Collaborative if one exists in your local area.
  • The commitment to represent diverse communities of PLWHA locally, statewide, and regionally. 

Applicants must submit a resume or bio and a supporting letter of reference from a Ryan White grantee. The deadline to submit applications is December 15, 2013. NQC staff will review all applications and inform applicants if they were accepted by January 2014.


Learn more and apply | nationalqualitycenter.org/CAC


Questions regarding the NQC CAC recruitment process or portfolio of services | Daniel Tietz at det01@health.state.ny.us or 877-874-0776.


> NQC News | in+care Campaign


December Focus: Digital Technology to Improve Health

The in+care Campaign is focusing on digital technology to improve health and retention in HIV care in December. New technology offers new opportunities to better serve our patients, but it also introduces new challenges to the quality of care. Presentations on this topic will focus on use of social media, smart phone applications, text messaging, and other digital health technologies that could help improve communication with patients. If you have any insight on retention strategies based on digital health technologies, please submit your lessons learned to Campaign staff | Improvement Updates


Upcoming Events


in+care Campaign Webinar | State-Level Efforts to Link New Patients to HIV Care

December 4, 2:00 pm ET

Linking people with HIV into care takes a village. There is a great deal that individual provider agencies can do to link and retain people with HIV to medical care, but even more can be accomplished when the providers work together; especially when state and city networks implement strategies across their funded providers. The state of Ohio will share its state-level efforts to link new patients into HIV care in this call.

Dial-in Number: 866.394.2346
Participant Code: 394 154 6368 #
Webinar URL: http://www.nqcqualityacademy.org/incarecampaign


Partners in+care Webinar | SPNS Projects Examine Retention in+care for HIV-Infected Transgender Individuals

December 10, 2:00 pm ET

In 2012, HRSA funded a new SPNS project examining retention in HIV care among transgender women of color. During this webinar, JoAnne Keatley, Director of the Center of Excellence for Transgender Health at the University of California at San Francisco will provide an overview of the issues faced by this community with regard to their retention in HIV care. In addition, Dr. Freddy Molano from Community Health Network of New York City will discuss specific interventions that medical providers can try to improve their transgender patient retention. The webinar will conclude with a panel discussion on this topic involving both consumers and providers.

Dial-in Number: 866.394.2346
Participant Code: 397 154 6368 #
Webinar URL: http://www.nqcqualityadacemy.org/incarecampaign


For both webinars, no prior registration is needed - just click the webinar link to join, click Guest and type in your name. If you have any questions, comments or concerns you would like addressed during the presentation, please send them to Michael Hager in advance (Michael@NationalQualityCenter.org).


Next Steps for in+care Campaign

While the in+care Campaign is moving into a sustaining phase with less frequent activities, the Campaign is not ending. The website and database will continue to be maintained for the foreseeable future. The learnings and updates for the in+care Campaign will be incorporated into NQC announcements, newsletters, and TA webinars beyond January 2014. Campaign staff is currently finalizing new enhanced reports to show comparisons based on Part funding, organization case load, and organization facility type. A brand new report is also being finalized that will describe which interventions have been implemented to improve patient retention in HIV care.


For questions related to the in+care Campaign, email Michael Hager at Michael@NationalQualityCenter.org or visit the Campaign website | www.incarecampaign.org.

> Quality Corner: Gurabo Community Health Center's Ongoing Work in Support of Retention


The Gurabo Community Health Center's SIVIF Program, a Part C grantee in Puerto Rico, has been trying various approaches to support retention in care over the past year and tracking the results. Their results show the importance of ongoing effort in this area--retaining patients is not a one-time proposition. And the efforts have paid off with a significant impact in viral load suppression, one of the main benefits of retention. The program has achieved 82 percent viral load suppression in patients in 2013 versus 70 percent in 2012 - an increase of 12 percent in a two-quarter period. The program expects to achieve or exceed its end-of-year goal of viral suppression in 86 percent of patients.


"Through the work of our Quality Committee in this area we have seen over time significant changes in our participant retention and integration of new patients in our program," says Denise Vega, Quality Coordinator. "With our retention strategies we are able to maximize our efforts in preventing patients from being out of treatment for a long period of time."


From March to April 2012, the clinic identified 63 patients who were due or overdue for appointments and initiated various activities to re-engage them. During the one-month period, 68 percent of the patients were contacted by phone and new appointments were scheduled. Mail reminders, which highlighted the services provided by the clinic, were sent to 10 percent of the patients. Six percent were referred to case management for follow up. At the end of the one-month period, only 16 percent of the patients had not been reached and were still lost to care.


Contacting patients by phone is an important part of the clinic's strategy to re-engage patients. However, in 2012 when these activities were reported, this was a challenge because the clinic had only one telephone line (the clinic has since moved to a new facility with more lines). This limited the ability of staff to reach out to patients. Despite this limitation, most patients received reminder calls on the day before their appointments. One day a week, the case manager and health educator reviewed patient records and contacted patients who had missed appointments and made reminder calls for upcoming appointments. Patients reported that they appreciated this level of contact.


One year later, the clinic conducted a similar analysis for the same one-month period. This time, 61 patients were identified as due or overdue for appointments. Of these patients, appointments were scheduled for 77 percent of patients, 11 percent were referred to case management, and 11 percent remained out of care. At the same time, the clinic was initiating activities designed to support patients. A new transportation service was launched and the clinic hired a new receptionist. These strategies are designed to facilitate patients' ability to engage in care.


These efforts to support client retention are made possible through the ongoing efforts of the clinic's staff with leadership from Marlene Perez, Project Coordinator, Dr. Rosa Castro, Executive Director, Dr. Caridad Vargas, Medical Director, and the Board of Governors of Gurabo Community Health Center who provides the resources needed to maintain this initiative.

> NQC e-Newsletter | Volume 6 | Issue 66 | Dec 13 


Quick Links


> Upcoming Events | November - December

> Upcoming Events | December


December 2 | in+care December data submission due


December 4 | in+care Campaign Webinar | State-Level Efforts to Link New Patients to HIV Care


December 15 |  CAC Application Deadline


December 19 | National TA Call | Back to Basics - Quality 101


December 20 | Partners in+care Webinar | SPNS Projects Examine Retention in care for HIV-Infected Transgender Individuals

> NQC Training Reminder | TOT and TQL in 2014


Don't forget to register for the upcoming NQC trainings. The Training-of-Trainers (TOT) session will take place in Cleveland, OH on March 11-13, 2014 and a Training of Quality Leaders (TQL) will take place on May 6-8, 2014 in Kansas City, MO. The application process is open, and all applications are available on our website.  


Training-of-Trainers (TOT) Program

The TOT Program is designed to build capacity for quality improvement among quality managers. It is designed for individuals with a strong experiential background in quality management. Since the purpose of the TOT Program is capacity building, participants are asked to lead at least three trainings within 120 days of completing the session. The goals of the TOT program include:

  • Enlarge the pool of qualified trainers on quality improvement in HIV care across the country
  • Further spread quality management concepts by increasing the number of training opportunities for Ryan White grantees
  • Increase the ability of NQC to refer requests for QI training to regional TOT trainers
  • Build capacity in Ryan White-funded programs on quality improvement 

Learn more about and/or apply to the TOT  | nationalqualitycenter.org/index.cfm/17290


Training of Quality Leaders (TQL) Program

The TQL Program aims to build the capacity of quality managers and those who direct quality management programs to effectively lead and facilitate quality improvement activities. It provides participants the ability to enhance their own expertise in quality management and support team dynamics. The goals of the TQL program include:


  • Increase confidence and mastery in facilitating quality improvement teams and in effectively managing quality improvement-related meetings in HIV care environments
  • Identification of leadership behaviors needed to lead an effective QM program and a better understanding of their implications for quality improvement activities
  • Exposure to quality improvement experts with practical knowledge and experience and to a network of peers with hands-on experiences

Learn more about and/or apply to the TQL | nationalqualitycenter.org/index.cfm/5847/19644

> Consumer Perspective | Angel Hernandez


Angel Hernandez feels strongly about promoting consumer involvement in HIV care, but this commitment can result in a lot of time behind the wheel. Angel serves on three quality-related committees in Puerto Rico: the Continuous Quality Improvement Committee of the Ryan White Part C Program, the Part B Steering Committee on Quality, and the Ryan White Quality Improvement Committee (the NQC regional group for Puerto Rico). Since he lives in Orocovis, which is located in the center of the island, driving to monthly or quarterly meetings can sometimes mean as much as a three-hour round trip.


He initially got involved as the consumer representative to the Part C committee, which is made up of most of the Part C grantees in Puerto Rico and their subgrantees. He brought his extensive professional experience to this work. Trained as an accountant, Angel worked from many years in hospital administration in both the public and private sectors. To build on these skills, Angel attended the NQC's Training for Consumers on Quality this past spring.


Each of the committees Angel is involved with takes a slightly different approach to quality. For example, the Part C committee focuses on outcomes at the clinic/subgrantee level while the Part B Steering Committee looks at the larger clinics operated by the health department. All three are very focused on collecting the data necessary to measure clinical performance and outcomes. While this type of measurement is important, according to Angel, it is just as important to gain consumer input about how services are provided-how consumers are treated during appointments and the ease by which they can navigate the care system.


"Not many consumers-especially those in rural areas-understand that they can be part of improving services," says Angel. "I really want to get these consumers involved. They are an essential part of the process and need to provide their perspective."


To encourage consumers in Puerto Rico to participate in quality-related activities, Angel developed a YouTube video in Spanish that describes the importance of consumer advocacy and provides tips for getting involved . To ensure that Spanish speaking consumers have access to many of the tools developed by NQC, Angel has volunteered to work with NQC to make more resources and tools available in Spanish.


"Consumers must bring their experiences to the table, particularly for those non-clinical indicators and issues which might affect the quality of care," says Angel.

> Quality Tip of the Month | A Brief Word about Data 


Much like the now popular Higgs Boson, data are fundamental building blocks of quality improvement. As W. Edwards Deming once said "In God we trust. All others must bring data." An organization dedicated to improvement relies on data to plan its improvement strategies. Reflect on your experiences with data and remember these helpful tips:

  • A picture is worth a thousand words. Graphs go a long way in making the data easier to understand
  • Make sure the data are accurate; spend time in "cleaning" your data so you can make the right decisions
  • The instrument you use to collect the data must be well thought out and have clear, well-defined instructions for its use
  • One-time data are not as useful as data collected over time; a long-term approach shows performance and allows you to learn from your successes and failures
  • Data are best when shared and shared in a manner that can be easily understood and used by others in the organization

However you collect and examine your data, it is an important partner in your quality improvement journey.

> National TA Call | Back to Basics - Quality 101


This month NQC will return to the future - basic quality improvement principles and practice. Quality is here to stay, and since NQC's inception, Ryan White Program grantees have embraced quality improvement. Despite of budget cuts, increasing caseloads, and having to "do more with less," grantees have made significant strides. New staff joining Ryan White funded grantees can use this as an opportunity to learn about quality principles and practices. It can also serve as a refresher in the fundamentals for existing staff. The learning objectives for the call are:

  • Key principles of quality improvement
  • A brief word about data
  • The PDSA Cycle
  • Using QI tools

Please join us; this will be an informative call and a good way to increase your QI IQ.


December 19, 2013 at 3:00 PM (ET)

Join the webinar | http://www.nqcqualityacademy.org/tawebinar/

Dial in for audio: 866.394.2346 and use passcode 3971546368#


Remember: The NQC Quality Academy has 24 tutorials focused on quality. This valuable resource is available 24/7.

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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