STOP HIV/AIDS Collaborative & Quality Improvement Network -Day 1-Workshop 2 - Provincial... ·...

STOP HIV/AIDS Collaborative & Quality Improvement Network Dr. Rolando Barrios

Assistant Director BC Centre for Excellence in HIV/AIDS

Christina Clarke Quality Improvement Advisor Impact BC

1. Describe an improvement approach to facilitate change and improve patient care and outcomes

2. Understand the collective impact of the Collaborative on systems and patient outcomes

3. Locate additional resources based on interests

Objectives

What do you know already about the Collaborative or HIV Quality

Improvement Network?

What we knew when we began

1. Treatment is good for the individual, the population and saves the system money.

2. Effective chronic disease management produces better patient care and outcomes

The Chronic Care model:

Prepared practice teams interacting with informed, activated patients through continuous healing relationships supported by the ongoing availability of health information.

3. Great ideas and best-practices were isolated in areas throughout BC; we needed to spread this

around

4. The diffusion and adoption of best-practices doesn’t occur spontaneously; it requires effort and

support

What we know

What we do

What we do

The STOP HIV/AIDS Collaborative began to close the gap between what we know and

what we do

What we know

Collaborative methodology

A structure for learning and action that aligns healthcare providers in a common aim and

shared measurement system to make incremental system-level changes to increase

access and uptake of effective HIV care and treatment.

The Collaborative Model

Participants

P

S

A D

P

S

A D

P

S

A D Closing

Congress Launch LS1 LS2 LS3

Prep AP2 AP3 AP4

Monthly Teleconference Calls Website

Webinars

Electronic Mailing list Messages

Faculty Discussion Forum Site Visits

Action Period Supports

Leadership Committee

Select Topic

Expert Committee

Create change package,

charter, etc.

13 Months

Holding Gains

Adapted from the Breakthrough Series Model, Institute for Healthcare Improvement

What are we trying to accomplish?

Shared aim:

• Improve retention in care

• Improve HIV care and services

• Strengthen partnerships in care

How will we know that a change is an improvement?

Shared Measurement:

1. Date of last primary care visit

2. HIV Viral Load

3. ART uptake

4. Virologic control

5. Patient experience with care

What changes can we make that will lead to an improvement?

Incremental system-level changes using ideas from different sources:

• Clinical guidelines

• Chronic care model

• Patient insights

• Expert ideas

• Colleagues


Participants

P

S

A D

P

S

A D

P

S

A D Closing

Congress Launch LS1 LS2 LS3

Prep AP2 AP3 AP4


Webinars





Select Topic

Expert Committee


charter, etc.

13 Months

Holding Gains

Adapted from the Breakthrough Series Model, Institute for Healthcare Improvement

• Interior • Outreach Urban Health (Kelowna)

• Island • Nanaimo • North Island Liver Services (Courtenay) • Port Alberni • Victoria

• North • Central Interior Native Health Society (Prince

George) • Smithers

• Vancouver area • BC Women’s Hospital/Oak Tree Clinic • Immunodeficiency Clinic • Dr. Peter Centre • DCHC & MAT • Three Bridges • Pender Clinic • Primary Outreach Services • Portland Hotel Society • Raven Song • Vancouver Native Health Society


Participants

P

S

A D

P

S

A D

P

S

A D Closing

Congress LS1 Launch LS2 LS3

Prep AP2 AP3 AP4


Webinars





Select Topic

Expert Committee


charter, etc.

13 Months

Holding Gains

Learning Sessions Teams come together in face-to-face meetings to engage in learning, sharing, and action planning.

In between Learning Sessions

Testing and measurement

PDSA cycles (Plan, Do, Study, Act)

Similar to the scientific method only faster. Start with

a prediction (Plan), carry out the test (Do), analyze

what you’ve learned (Study), and then decide

whether you will adapt, adopt or abandon your

change (Act).

We also measure. Purpose of measurement:

Solberg et al The Three Faces of Performance Measurement:

Improvement, Accountability and Research. Journal on Quality

Improvement, Volume 23, Number 3, March, 1997.

Research

Improvement

Accountability/evaluation

Comparing types of measures

Improvement Accountability Research

Aim Improve care

Comparison, choice,

reassurance, spur change

New knowledge

Timeline Often very brief,

weeks to months

Varies Often takes

years

Test Observability

Test observable Test observable

or no test Test may be

blinded

Bias Accept

consistent bias

Measure and adjust to reduce

bias

Design to eliminate bias

Improvement Accountability Research

Sample size

“Just enough” data--work into routine, low or no budget

Obtain all relevant available data.

“Just in case”

data.

Major budget expense.

Hypothesis

Flexible, change as learn, part of work process

May not be a hypothesis

Fixed hypothesis

Testing strategy Sequential tests One test or no

test One large test

Confidentiality of data

Data used by improvers only

Data available to public

Protected data and restricted access

Who measures? Improvers External Highly skilled

external team

On January 31st 2012 the Collaborative transitioned into the HIV Quality Improvement

Network

Increasing peer leadership & focus on sustainability with support and direction from the Response Team

What we observed from this Collaboration:

•

•

•

•

•

67%

74%

87% 90%

90%

92%

91% 92% 90% 91% 90%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Fig 1. Proportion engaged in care

67% 73%

86%

89% 88% 90% 90%

88% 84% 86% 84%

40%

50%

60%

70%

80%

90%

100%

Fig 2. HIV primary care visit every 4 months

84% 82%

76%

86% 88% 87%

81% 84%

86% 85%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Fig 3. HIV plasma viral load test every 4 months

91% 90%

92%

96%

94%

96% 96%

95%

96% 96%

85%

87%

89%

91%

93%

95%

97%

99%

Fig 4. ART uptake among unequivocally in need4

0%

20%

40%

60%

80%

100%

Fig 6. Proportion of teams collecting and using patient feedback

93%

91%

92%

94%

92%

91%

93%

94% 94% 93% 92%

85%

87%

89%

91%

93%

95%

97%

99%

Fig 5. Maximal virologic control

•Government of British Columbia

•STOP HIV/AIDS Leadership Committee

•Collaborative Planning Group

•Interior Health

•Northern Health

•Provincial Health Services Authority

•Providence Health Care

•Response Team (Bethina

Abrahams, Misty Bath, Janice Jespersen, Paul Kerston, Sam Milligan, and Ashnoor Nagji)

•Vancouver Coastal Health

•Vancouver Island Health Authority

Acknowledgements

Thank you! More information at stophivaids.ca or

contact [email protected] or

[email protected]
mailto:[email protected]:[email protected]

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