Part A Quality Management

A Summary of QI Initiatives and Projects2008-2016

Presented by:Dana D. Hines, PhD, MSN, RN

March 18, 2016

2008

New TGA capacity building initiative

Group 1 HAB measures

QM committee becomes standing committee on PC

Formed perinatal workgroup to evaluate rate of perinatal transmission in the TGA

2009

Training of the Trainer and Total Quality Leadership

SOC & QM committees develop local monitoring standards

CAREWare goes live at most agencies

“Get Papped” QI project to improve cervical cancer screenings

2010-2011

Acuity assessments for CM agencies

Capacity building, training, and redesign

Collaborative CM QM Plan

Case managementredesign

Launch of the floating medical case manager

QM-led medical transportation survey

2012

Stratified non-medical CM into two separate services

Treatment plans implemented for all service categories

Mandated annual substance abuse screenings

Mandated annual mental health screenings

2013-2015

Collected data on client’s concerns regarding access to care

Rolled out CAREWare case notes templates on a limited basis

QM committee-led survey on barriers to RWSP recertification

QM Plans

All agencies began developing and implementing their own QM Plan

QM

Plans

2016

Retrospective review of 2014 inactive RWSP

clients

415

415

RWSP Parts A & C case

management manual

In Progress

In Progress

Now until June 1st

2014 Inactive Clients by Race/Ethnicity

81; 40%

101; 49%

7; 3%16; 8%

AA White Asian/PI HispanicN=205

2014 Inactive Clients by Gender

33; 16%

171; 83%

1; 0%

Number

female maleMTF

N=205

2014 Inactive ClientsLast CD4 Count

December 2014 or earlier

Jan-June 2015 July-Dec 2015 Missing CD4 count

86/205 (42%) 41/205 (20%) 53/205 (26%) 25/205 (12%)may be lost to care, deceased, or OOJ

Of the 86, 10 died during this timeframe (December 2014 or earlier)

Of the 41, 2 died during this timeframe (Jan-Jun 2015)

76/205 (37%)Lost to care

39/205 (19%)Lost to care

N=20556% (n=115) of the 205 cases reviewed thus far are lost to care

Systems Level Challenges

Data Management & Integration

Retiring workforce of HIV community

leaders

Service Access & Delivery

Data Management & Integration

• Multiple, uncoordinated data management systems

• Ryan White funded providers using multiple data systems– CAREWare– Case manager– Gopher or G3 (Soon to be EPIC)– iSalus– Other hospital-based EMRs

Service Access & Delivery

• Lack of universal RWSP application• Overlapping role definitions for care

coordination (ISDH) and case management (CM) (MCPHD)

• Lack of clarity regarding medical and non-medical CM

Service Access & Delivery

• Confusion regarding service definitions – Psychosocial and outreach

• Recertifying eligible clients for RWSP• No standardized process for identifying and

reengaging clients lost to care• Lack of Hispanic/Latino service providers

Stretch Goals for the TGA and State• Implement a shared state and

county data management system for dually funded service providers

• Activate data sharing among agencies with shared clients

• Facilitate quarterly meetings between state-funded CC and MCPHD-funded CM

• Conduct a state-wide needs assessment of the transgender population in Indiana

• Engage in succession planning to maintain a pool of competent and capable HIV leaders in the community

• Continue to integrate QI at every level of service entry and across all steps of the Care Continuum

• Explore and apply for grant opportunities that provide unrestricted dollars for HIV services across the Continuum

Food for Thought

• “The most damaging phrase in the language is: ‘It’s always been done that way.'” ~ Grace Hopper