> NQC Update | Three New Quality Improvement Publications from NQC 

Put these at the top of your summer reading list! NQC has released three new resources designed to help Ryan White HIV/AIDS Program grantees enhance their quality-related activities.

Cross Part Quality Management Guide

The Guide is designed to serve as a tool for establishing cross-Part collaborations among Ryan White HIV/AIDS Program grantees and to provide a roadmap for local quality champions who lead the process. A learning collaborative is an initiative in which teams of providers come together to study and apply quality improvement methodology to a focused topic area. First conceived by the Institute for Healthcare Improvement (IHI) in 1994, learning collaboratives help organizations apply known improvement principles to health care practices. The Guide describes the steps necessary to engage grantees across all Part funding streams in a collaborative approach to improving HIV care across a region and has useful information for those preparing to initiate the process and those who want to strengthen their efforts. It describes how to gain buy-in from leadership and the steps to initiate quality improvement activities. Those further along in the process can compare their approaches and consider ways to strengthen their current efforts.

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Partnering with Subcontractors to Improve HIV Care

This Guide captures the combined experiences and accomplishments of Ryan White HIV/AIDS Program grantees and their subcontractors. It explores how to integrate subcontractors into quality-related activities to improve HIV care and how to build their capacity to carry out these activities. In addition, it features examples of on-site consultations by NQC staff and coaches who guide Ryan White HIV/AIDS Program grantees through the challenges and key tasks related to improving the quality of HIV care. The Guide also features best practices from experienced Ryan White stakeholders, real world tips from quality improvement experts in the field, and concrete tools to strengthen current quality management efforts.

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Training of Consumers on Quality Guide

The NQC Training of Consumers on Quality (TCQ) Program targets consumers who seek to be effective quality advocates for their communities with the goal of improving the quality of HIV care. The purpose of this NQC TCQ Program is to build the capacity of HIV-infected consumers to be active partners in the planning, implementation, and evaluation of quality improvement efforts at both the clinical and system levels. The direct outcome of this training program is to increase the number of people living with HIV who fully participate in ongoing agency-specific as well as regional quality improvement activities.

NQC has been carrying out in-person trainings for consumers. This Guide will serve as a training tool and ongoing reference for future participants. It can also be used by others to conduct similar trainings in their communities. It contains detailed descriptions of all pre-TCQ activities and assignments, post-TCQ activities, faculty notes for each module during the 2-day TCQ session, and links to available quality improvement resources.

> Provider Corner | South Carolina Regional Group

After years of regular meetings, South Carolina's Regional Group is taking a more formal approach to their collaboration. In the past year the group has worked with NQC quality coach Barbara Boshard to develop a charter, quality management plan, and a work plan.

"The NQC coach was a driving force for the development of our quality plan. At first there was some eye rolling and some members thought that this was unnecessary," say Aaron O'Brien, a program analyst at Roper St. Francis Healthcare and a co-chair of the Regional Group. "As we moved through it, the value of the planning process became obvious."

As a result of the charter and shared work plan, members now have a shared set of goals and are using common performance measures. Specifically, they are using in+care Campaign measure related to viral load as well as a measure to track patient appointment adherence.

Another major change for the Regional Group is the sharing of data. This also grew out of the in+care Campaign. Initially, data were blinded but as members got more comfortable with sharing, the data were unblinded.  Blinding in this context means that the various agencies were not identified as results were shared.  Over time, the agencies found that it would be useful to unblind, or identify their results.

"Seeing the data has been really helpful," says Aaron. "It encourages the sense that we are a community of learners. There was no shame related to unblinding the data."

The group has built on this effort and used the NQC assessment tool to breakdown the client-level data by race/ethnicity, gender, and age. They are looking at out-of-care patients by demographics and exploring strategies for improving linkage and retention for these populations.

Another benefit of the group is the sharing of best practices, which takes place at every meeting.

"We refer to it as the senseless sharing and shameless stealing session," says Rick Hatton, data and quality coordinator at Affinity Health Center and the group's other co-chair. "It has been wonderful to see members incorporate these practices."

At a recent meeting, two organizations provided details on their peer navigation programs. As a result, one of the members initiated their own peer program and has secured a capacity building grant to support implementation.

The group has also taken steps to increase consumer involvement and recently added a consumer from Affinity Health Center as a member.

"This consumer has been extremely active in our organization and has attended the NQC's consumer training," says Rick. "He cares about the quality of care and his voice will make a difference in the group."