NQC Logo


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




First of all on behalf of all the NQC staff I want to extend hearty congratulations to all the 2014 NQC Quality Award Winners. Each application we received showed the depth of commitment of Ryan White grantees to quality management and to the individuals they serve. The review committee was impressed with each and every application and it was not easy picking the winners in each category.


One of the most impressive findings is the increased level of sophistication over time of the quality management efforts of grantees and the leadership so many individuals have shown within their organizations. It is truly an honor to be able to assist such a dedicated community. 


Congratulations to our winners and while some grantees did not obtain an award, there are no losers because the outstanding work that was presented serves each and every patient. 




Clemens Steinbock

Director, National Quality Center


> In This Issue

> NQC News | 2014 Quality Award Winners
> NQC News | in+care Campaign Update
> Consumer Perspective | Trevor Pearson
> Quality Tip of the Month | Visual Display of Information
> National TA Call | Lessons from the Field | Real World QI Practice

> NQC News | NQC Quality Award Winners  



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.

> NQC News | in+care Campaign Update


The in+care Campaign is working on several exciting new things for the Ryan White community.


Changes to the in+care Campaign Database

We have heard your concerns that there should be greater access and flexibility of the benchmark reports. By August 31, participants will be able to run their in+care Campaign data entries based on their Part funding, state in which services are provided, case load, and facility type. No more reliance on staff to come out with enhanced reports every 6 months.



Coming soon! NQC is excited to unveil this new way to share improvement strategies and to link the strategies with the data entry of the in+care Campaign database.


in+care at IAPAC

The International Conference on HIV Treatment and Prevention Adherence (IAPAC), held in June 2014, provided a great opportunity for NQC staff to identify new voices to bring you for this year's webinars. In July, the Campaign will publish its calendar for the remainder of 2014 to help you plan.


Upcoming Journal Articles

Two journal articles are in the works. Preliminary drafts of both were presented by Michael Hager at the International Conference on HIV Treatment and Prevention Adherence. We anticipate that both articles will be ready for institutional review and publication by fall 2014.


The first article focuses on public health methods and the use of campaigns to drive quality improvement. Click here to see the slides


The second article focuses on the in+care Campaign and specific performance measurement results that show that the Campaign's national focus drove improvement in national HIV care continuum performance. Click here to see the slides.

> NQC e-Newsletter | Volume 7 | Issue 71 | Jul '14


Quick Links


> Upcoming Events | April - May

> Upcoming Events | July - September


July 17 | National TA Call | Lessons from the Field | Real World QI Practice


August 3 | in+care Data Submission Due

August 26-27 | Learning Session 2 | H4C Collaborative


Consumer Perspective | Trevor Pearson 


As a professional journalist, Trevor Pearson knows that knowledge can result in change. Wanting to learn more about available HIV-related services so he could pass the information on to other people living with HIV, Trevor joined the Atlanta EMA Planning Council in 2011. He is currently serving on the Quality Management and Priorities Subcommittees. As Co-Chair of the Quality Management Subcommittee, Trevor is using skills that he developed at the NQC's 2013 Training of Consumers on Quality.


"I learned how to use data as the driver for quality management," says Trevor. "People want change but they don't know what changes are needed. When we look at existing services we can use data to identify what is really needed."


Trevor emphasizes the importance of using data to tell the whole story.


"The data point to the needs of consumers as a whole," he says. "If you ask one person what is needed, you might just find out about their needs. We can use data to tell the story of all consumers."


In addition to his work on the Planning Council, Trevor has worked as a part-time peer navigator at AID Atlanta since March. This one-year pilot program is designed to help consumers stay in care. He works with consumers on a one-on-one basis to help them become more self-sufficient. In this role he often passes information on to the clinic staff.


"People are more willing to talk to me about issues they probably do not bring up with their primary care provider or other staff," says Trevor. "If there is something that is impacting care, I can pass it on."


For example, many of the people that Trevor works with have unstable housing and cannot always be in a safe place where they can take their medicine. Knowing that a consumer is facing such an issue can help staff identify strategies to support adherence to treatment.


In both his work on the Planning Council and as a peer navigator, Trevor serves as a bridge-taking information back and forth between consumers and providers. Just as he does as a journalist, he is getting the story out.

> Quality Tip of the Month | Visual Display of Information 


Many or most of you have at one time made a graph or some sort of chart to display your data.  Hopefully, your visual display helped convey the message you wanted to impart to your audience. But did it? Did you use the right graph for the data you have? Was it easy for your audience to understand? On average, a person will look at a slide for 5 to 7 seconds before their attention wanders until a new slide is presented. Your graph should tell its story succinctly and in such a way as to impart its message in that time. There are many types of graphs available and there are dozens of books written on this subject. Most of the time, simple run charts or pie charts are fine to help you tell your story. 


Some of you may have heard of the "Seven Basic Tools of Quality." This designation arose in postwar Japan and attribution has varied between Deming and Ishikawa - both of whom contributed mightily to the quality improvement work we do today. The tools consist of the Cause and Effect Diagram; Check Sheet; Control Chart; Histogram; Pareto Chart; Scatter Diagram; and Flow Chart. 


Tutorial 21 in the NQC Quality Academy walks you through preparing a Run Chart, Histogram and a Pareto Chart. To access this tutorial go to: http://nationalqualitycenter.org/index.cfm/17263.


NQC has also presented National TA Webinars on "Using Tools for Improvement." This tutorial provides you with instruction on developing flow charts. To access this presentation go to: http://nationalqualitycenter.org/index.cfm/17414/82434


These and many other resources available to you will assist you in distributing your data and engaging your audience. This is one of the first steps in engaging a larger audience in quality improvement and hopefully improving patient care. 

> National TA Call | Lessons from the Field | Real World QI Practice



This month, we will have presentations from three of our NQC Quality Award winners. List those who will present.  The presentations will discuss their efforts in Infrastructure, Performance Measurement and Quality Improvement Activities.


As you know, every month we try to bring grantees into our TA webinars to offer practical examples of how quality management (QM) principles and practice are put into use. This call will focus on the practical and reinforce the QM principles and practice NQC has brought to grantees. 


Please join us. This will be a tremendous leaning experience. 


For more information | nationalqualitycenter.org/index.cfm/17403 

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  


To join our mailing list click here  

If you would like a colleague to receive the NQC e-Newsletter, ask them to send an email to: news-join@NationalQualityCenter.org
. This will automatically subscribe them.


If you wish to unsubscribe, please send an email to: