Congratulations to the winners of the 2014 Quality Awards! Thank you to all who submitted nominations. It is always wonderful to hear about the great work going on across the Ryan White community.
Quality Improvement Activities
San Juan EMA, PR (Part A)
The EMA conducted a comprehensive system analysis that revealed there was no standardized process for ADAP certification. In response, in October 2013 a quality improvement project was initiated, with the goal that a minimum of 95% of the participants eligible for ADAP would obtain certification on time. Multiple activities were implemented, including training of pharmacy, case management, and medical staff in the use of CAREWare systems. Within two months the certification rate was 98.4%, an increase of 278.5% for on time certification of ADAP eligible participants compare to the July 2013 baseline of 26%.
Wake Forest University Health Sciences Ryan White Program (Part D)
The WFUHS Ryan White Program initiated a clinical quality improvement project focused on patient retention. The first step was to identify patients that had left the program (so that their cases could be closed out) in order to focus on the consumers who were truly lost to care. Each month, patient navigators and case managers receive a list of patients lost to care and they are responsible for bringing them back to care. After ten monthly cycles, 43% of these patients were linked backed to care, while others were accounted for (e.g., deceased, incarcerated). The remaining 30% have been referred to high-intensity outreach.
Performance Measurement
AIDS Resource Center of Wisconsin (Part C)
As a designated Level III Patient Centered Medical Home, ARCW provides integrated HIV and primary health, dental, and mental health care using enhanced electronic health record technology to improve performance and outcomes-82% of ARCW patient have undetectable or suppressed viral load. ARCW used Population Manager
software, a data aggregator that allows management and care team members to track performance at the agency, clinic, and provider level, to monitor preventive care and treatment of HIV patients with hypertension, diabetes, dyslipidmia, and depressions. In particular, ARCW has used the software to establish new clinic management processes and meet goals for cervical cancer screening and standardized depression screening.
Leadership in Quality
Shaundelyn DeGraffenreidt, Broward County, FL (Part A)
As Quality Assurance Coordinator for the EMA, Ms. DeGraffenreidt leads all quality management activities, including the EMA's participation in the in+care Campaign, where she has assisted with implementing custom reporting to allow for aggregate and client-level reports that capture the data for subgrantees. The EMA and the planning council use the reports to develop service category and system-level strategies to improve retention and viral suppression. To increase stakeholder involvement in quality activities, Ms. DeGraffenreidt restored the Miami/Dade/Broward Regional Quality Improvement Group and led efforts to revise the structure of the EMA's Quality Improvement Networks so that networks are comprised of subgrantees representing all locally funded Part A service categories. Network activities have focused on measuring and improving retention and viral suppression .
Quality Management Infrastructure Development
Inova Juniper Program, VA (Part C)
Inova Juniper has put in place a number of activities to build a comprehensive quality management program, which is guided by a full-time quality improvement consultant. An annual quality management plan is developed with significant input from the quality council, which is made up of a wide range of staff. Inova Juniper has implemented a "Quality Star" initiative-each month a "Quality Star" is selected from staff. This has proven to be beneficial in showing how staff-generated process improvements and ideas can benefit patients when implemented consistently and correctly.
Consumer Involvement
Nassau County Department of Health, NY (Part A)
The Quality Assurance and Membership Committee (QAM) of the planning council is chaired by a consumer and nearly half of the members of the QAM committee are living with HIV. 'Pods' or 'super-pods' - which are made up of consumer-led committees - are joined with content experts (mostly providers) who can help increase understanding of the financial, care, or legal barriers that might impact the delivery of cares. The Committee has addressed transportation, oral health, mental health, and Medicaid managed care.
in+care Campaign Award
Orange County, CA (Part A)
The Orange County TGA has conducted multiple activities to support retention: training of all grantee staff by the NQC; technical assistance for providers on quality management and quality initiatives; quarterly provider meetings with quality management trainings; and discussions and activities that providers can transfer to their staff. The TGA developed biannual newsletters for providers and consumers with information related to available services and retention. Improvement was seen on all four retention measures-for example, patients newly enrolled in medical care went from 57.53% in 2011 to 93.75% in 2013.
Gurabo Community Health Center, Puerto Rico (Part C)
In 2013 the quality improvement committee established the objective of increasing the retention in care by 15%. To reach this goal various activities were implemented: confirmation of appointments the day before; medical record audits of absent patients every week; and identification of patients missing medical visits and labs. As a result of these activities, the grantee saw an impressive increase in retention, better attendance at appointments, an increase in the number of new patients reached for care, and reduced viral load rates reflect these efforts.
