Celebrating 10 years of leading innovations across the Ryan White community.


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




Hopefully you all enjoyed the holiday season and feel invigorated to continue our work in ending the AIDS epidemic. This month, NQC profiles St. Luke's University AIDS Service Center because of their outstanding work in reducing their viral load rates. Each month, we try to bring you a profile of a grantee that has made an impact in AIDS care to provide you with new ideas.  We hope you find this month's profile valuable and adds to your understanding of how to improve viral load suppression rates.


I encourage you to apply to the Training of Quality Leaders (TQL) Program being held from March 31 through April 2, which will be held in Chicago, IL. Very soon, the 2015 Quality of Care Award and its application process will be announced. NQC will make sure that we do our best to meet the needs of all Ryan White Program grantees, so Join Us!


Tell us how NQC has helped you | Submit Your Testimony  


Clemens Steinbock

Director, National Quality Center

> This Issue

> NQC News | Training of Quality Leaders: March 31 - April 2, Chicago
> NQC 10th Anniversary | Reflections from the Field
> Provider Corner | St. Luke's University AIDS Services Center Wins Big
> Consumer Perspective | Nancy Asha Molock
> Quality Tip of the Month | PDSA Cycle Part 3 - GO!
> National TA Call |Choosing your Quality Improvement Project

> NQC News | Training of Quality Leaders: March 31 - April 2, 2015 in Chicago, Illinois  


Start the new year by resolving to build your quality management leadership skills! NQC is offering a Training of Quality Leaders (TQL) session March 31 - April 2, 2015 in Chicago, IL.


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 to lead an effective QM program and better understand their implications to lead quality improvement activities.
  • Exposure to quality improvement experts with practical knowledge and experience and to a network of peers with hands-on experiences. 
To apply to the TQL, go directly to the SurveyMonkey | https://www.surveymonkey.com/s/23FGGZL

> Jan. 2015 | Issue 75 | Vol 7 

Quick Links


> NQC 10-Year Anniversary
Milestones and Highlights

Tell us how NQC has helped you!

> Upcoming Events 

Jan. - Feb. 2015



January 15 | National TA Call | Choosing Your Improvement Project

February 1 | in+care data submission due


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



Improving HIV Care.

> NQC 10th Anniversary | Reflections from the Field 


For over 10 years now, NQC has provided assistance to Ryan White Program grantees on the practical application of quality management principles and practice.  We have brought innovative programs to grantees and leading-edge methods of program delivery. NQC continues to offer highly qualified consultants to help grantees achieve their quality management goals.  NQC is proud of its work but more importantly, we are proud to be making an impact in the Ryan White program.  Given that it is our anniversary, we have asked some NQC staff and consultants to reflect on their work over the years. Here is what they had to say.


NQC's communities of learning have offered unique ongoing opportunities for quality management learning and peer-to-peer sharing and networking since 2006. As the national response to HIV has galvanized around the National HIV/AIDS Strategy and the President's Care Continuum Initiative, NQC's communities of learning have helped align quality of care focus and initiatives across the U.S. and across the Ryan White Parts. The HIV Cross Part Care Continuum Collaborative (H4C) involves five states that have created a special cohort of HIV-infected individuals that are not virally suppressed to focus their collective energies on achieving high rates of viral load suppression. Soon participants of past NQC collaboratives will be invited to join the H4C discussion to further disseminate learning. NQC continues to follow and promote the progress of Ryan White grantees participating in the in+care Campaign.


- Michael Hager, MPH, MA Manager of Communities of Learning


Each month NQC's newsletter features a Ryan White provider and a consumer involved in quality-related activities. As I conduct the interviews necessary to develop these profiles it is always obvious that both providers and consumers have a deep appreciation for the systemic nature of quality improvement. They look at the big picture and appreciate the details. They know the importance of involving everyone within the organization-from management to the receptionist. And, they think outside the box to come up with solutions to the problems they identify. You can draw a direct line from the topics covered in NQC trainings that these providers and consumers have participated in to these outcomes.

- Paula Jones, Writer, NQC eNewsletter
Provider Corner | St. Luke's University AIDS Services Center Wins Big


It is always nice when hard work and success is recognized. Last September we featured the AIDS Services Center at St. Luke's University Health Network in Easton and Bethlehem, Pennsylvania Ryan White Part C?. We described several of their quality improvement activities-and we were not the only ones impressed with their efforts. The St. Luke's Quality Awards are a network wide initiative covering five categories-people, service, finance, quality and growth. Last fall, the Center won first place in the people and service categories. The Center also was awarded the President's Award, which is chosen from all the winners.


The Center's award-winning work started in June 2013 when a quality improvement team was formed to address the 24 percent of patients who had not yet reached viral load suppression ;.the Center's goal was to reach 85 percent. The team used brainstorming, a fishbone diagram, and a Pareto chart to identify potential barriers to viral load suppression. The PDSA process was then used to form and test interventions on the most common barriers to viral load suppression. Throughout the year the CAREWare database was utilized to run lists of patients who had detectable viral loads so that all new patients were included in the project. A consumer panel was formed and utilized to assess patient knowledge of viral load suppression and to identify ways staff could better educate patients on the importance of adherence to antiretroviral therapy. After a year of work, of the 56 patients who had detectable viral loads during the project, 35 achieved viral load suppression. The viral load suppression rate improved to 88 percent, surpassing the goal set at 85 percent.


The Center identified several factors that can impact viral suppression rates. 

  • Patients New to Antiretroviral Therapy

Over the 12-month project, there were 15 non-suppressed patients who were brand new to antiretroviral therapy. By the completion of the project, 11 of them had achieved viral load suppression. The four remaining patients had seen successful decreases in their viral loads but were not yet undetectable. All four remaining patients started with a full AIDS diagnosis and extremely high viral loads. This reinforces the need to promote HIV testing so that people can enter treatment sooner. 

  • Patients with Mental/Emotional Health Barriers

The Center's behavioral health consultant reviewed the chart of every non-suppressed patient. Of the 28 patients who were identified as having mental/emotional health barriers, four were already enrolled in private mental health services. The consultant identified significant mental/emotional health concerns in an additional four of the patients and assisted in connecting them to private mental health providers. Nineteen (19) of the remaining patients met one-on-one with the consultant to work on developing coping skills and to receive emotional support. By the completion of the project, 15 patients who were identified as having mental health barriers achieved viral load suppression. 

  • Communication Challenges

Fifteen (15) patients were identified as not being in regular communication with the Center or difficult to reach. By the end of the project only three patients remained on the list of having no accurate contact information. Two of the original patients who were not in regular communication became connected and achieved viral suppression. Six of the patients were located, are now in communication with the clinic, and have started antiretroviral therapy. Five of those six have shown significant decreases in their HIV viral load. Four of the patients have had their files closed as a result of being unable to contact them. 

  • Patient Insurance

Of the 56 patients who were non-suppressed during the course of the project, 23 were identified as having insurance barriers. Insurance issues included having no insurance, inactive out of state plans, and some patients were only enrolled in the state AIDS Drug Assistance Plan (ADAP), which does not provide coverage for appointments or hospitalizations. The QI team member assigned to review insurance coverage reported that 12 of these patients were able to work one-on-one with a case manager to enroll in Medicaid programs. Of those 12, eight are now virally suppressed and the other four are on antiretroviral medications and showing reductions in their viral load. Eight of the uninsured patients were closed to the clinic after being deemed inactive for longer than two years. At the conclusion of the project, three patients remain uninsured. Of those, two are now connected to the state ADAP, are on antiretroviral medications, and are showing reductions in their HIV viral loads. 

  • Importance of Accurate Data Entry

At the start of the QI project every patient who was listed as non-suppressed had their chart reviewed to make sure the CAREWare database truly reflected the most recent laboratory values. After all missing lab values were entered the viral load suppression rate increased to 80 percent. A new process for entering lab values into CAREWare was initiated by the QI team. Given that patients complete lab work as frequently as every six weeks, the clinic receives lab results daily. A folder has been established in both the office and the clinic so that any staff who receive results can collect them in one location. The adherence nurse now reviews the folders and enters lab results weekly to make sure the rates reflect the most current data.


While the significant increase in viral suppression may be what attracted the judges, it may have also been the thoughtful approach the crossed all aspects of the Center's work-something that makes NQC proud. Congratulations to the AIDS Service Center! 
> Consumer Perspective | Nancy Asha Molock 


When she says her focus is on thinking positive, Nancy Asha Molock is not referring to her HIV status. Ever since she was diagnosed in 2002, Nancy has been writing inspirational statements.


"It was a way to pull out my pain and counteract all the negative reactions and stigma," states Nancy.


Nancy showed her work to a friend, who offered encouragement. After classes in creative writing and publishing, Nancy compiled her thoughts into a book. Gaining Strength from Weakness: 101 Positive Thoughts for HIV Positive People has been published and is available on Amazon and Barnes & Noble websites. The book includes inspirational statements and allows readers to record their own thoughts.


The workbook is just one of Nancy's activities related to living positively. The former school teacher has become involved in her community-with a focus on improving care and also empowering other women living with HIV.


Nancy is active on the quality improvement committee for Bebashi-Transition to Hope, a Philadelphia-based AIDS service organization. As one of three consumers on the committee, Nancy provides input on issues related to medical case management, with a focus on getting consumers to appointments and keeping them in care.


"We need to look at issues of access and retention from the perspective of the consumer," says Nancy. "That is the input I can provide."


In addition to her work with Bebashi, Nancy serves as a co-chair of the Philadelphia chapter of the Positive Women's Network (PWN). In this role she organizes meetings twice a month to help women build their advocacy skills and take a more active role in their care.


While Nancy has tried to focus on the positive since her diagnosis, it was not until she took part in the NQC Training of Consumers on Quality in June 2012 that she became more involved with Bebashi and PWN.


"The consumer training was a catalyst for me," states Nancy. "It gave me confidence and let me know I could be more proactive in terms of my own care and advocating for the care of others. Meaningful involvement in care is critical and consumers need to take a proactive role."


Nancy admits that sometimes this can be a challenge-acronyms and technical terms can make it hard to keep up with the work of the quality committee.


"I just ask questions and make people explain things," says Nancy. "I am at the meetings to contribute. I am not there as a token. I need to understand so that I can provide my input." 
> Quality Tip of the Month | PDSA Cycle (Part 3) Go!


This is the last in our three part series on the PDSA Cycle and the most important step - starting! 

PDSA Cycles are learning experiences. They test the ideas of your committees to help your organization achieve improvement.  Not every PDSA Cycle will result in "success" for whatever reason.  The important thing is that each PDSA Cycle is a lesson to build upon.  Remember, start small, think of the rule of ones - use one person for one day in one location (if applicable).  Then look at your results, if they match your predictions, expand the scope of your tests.  However, expand it slightly, don't rush to finish this very important piece.  After you run at least a few tests, and are sure your improvement idea is sound based on your results, then roll the final product out.  Nothing creates chaos in an organization more than an idea that's tested once (or not at all) and then is rolled out to everyone.  Tests equal learning and learning leads to better ideas.  All of our patients and clients deserve our best.


For more information on PDSA Cycles, please go to Quality Academy Tutorial 13, The PDSA Cycle or How Can We Accelerate Improvements in HIV Care? 

This tutorial focuses on the PDSA Cycle: what it is, how it fits into the Model for Improvement, why it is important, and how to use the PDSA Cycle in HIV programs. The module provides numerous examples and tips for success to help people avoid pitfalls and easily integrate this model in their quality improvement activities.




"Get out of your own way... stop the paralysis by analysis... decide what you want, create a simple plan, and get moving!"
Steve Maraboli, Unapologetically You: Reflections on Life and the Human Experience

> National TA Conference Call: Choosing Your Improvement Project


January 15, 2015 at 3:00 - 4:30 pm ET

Our call this month will focus on how to choose an improvement that will have impact in you Ryan White Program.  Many grantees have rich sets of data at their disposal but struggle with setting improvement priorities.  This month NQC will help you think through setting priorities and moving to improve. 


Learning Objectives:

  • Understand what your data is telling you
  • How to set priorities for your quality improvement work
  • Choosing the project that will have the most impact


Meeting information  
Topic: Choosing Your Improvement Project  
Date: Thursday, January 15, 2015  
Time: 3:00 pm, Eastern Standard Time (New York, GMT-05:00)  
Meeting Number: 642 011 757  
Meeting Password: nqctacall123  

To start or join the online meeting 

Go to 



Add this meeting to your calendar: https://meetny.webex.com/meetny/j.php?MTID=m9d97889e613a52b136abcbd4702d69bd 



Audio conference information



If you have a direct line (people can call you directly)


Enter your number into the box that pops up and click the Call Mebutton on the bottom of the pop up.


If your calls need to go through a switchboard

Toll Free: 1-844-633-8697  
Alternate Toll Free - (For callers not able to call the 844 Toll Free Number): 1-866-776-3553  
2. Follow the instructions that you hear on the phone.  

Cisco Unified MeetingPlace meeting ID: 641 011 757  


> 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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