2016 NYS HIV Quality of Care Review

Transcription

1 2016 NYS HIV Quality of Care Review A new way forward in four parts Bruce Agins, MD, MPH Medical Director NYSDOH AIDS Institute December 15, 2016

2 Ending the Epidemic: update! A 3-Point plan announced by the Governor on June 29, Identify all persons with HIV who remain undiagnosed and link them to health care. 2. Link and retain those with HIV in health care, to treat them with anti- HIV therapy to maximize virus suppression so they remain healthy and prevent further transmission. 3. Provide Pre-Exposure Prophylaxis (PrEP) for persons who engage in high-risk behaviors to keep them HIV negative Goals, Legislative Amendments & Initiatives: December 1, 2016 Zero AIDS Mortality Zero HIV transmission through IDU Removing the upper cap on AIDS for HIV test offers Standing orders for STD screening 7 day PEP starter kits All service providers and care management systems will report VLS rates

3 The aim of the 2016 review, in brief Accelerate clinic-level efforts to End the Epidemic in NYS by 2020

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5 Part I: Organizational treatment cascades Purpose: QI To monitor the extent and quality of care being delivered to all HIV-positive patients seen in an organization, and not just those that are actively engaged in its HIV program. To identify gaps in the sequences of steps between diagnosis and viral load suppression as they are delineated by the cascade. To develop data-driven plans to assess progress in providing care, identifying gaps in care, and driving improvements to address these gaps through quality management programs and QI activities.

6 Part I: Organizational treatment cascades Purpose: EtE To assess how all PLWH who touch an institution are linked to ongoing care that results in achievement of viral load suppression. To identify areas of focus for reaching and engaging those patients in the community who are not connected to care and to spark associated improvement activities within the community and in partnership with other agencies. To visually portray the success of agencies in achieving both patient and public health outcomes related to Ending the Epidemic.

7 Part I: Organizational treatment cascades Expectations By March 31, 2017, organizations will be expected to submit: 1. A treatment cascade that tracks the care of newly diagnosed patients. 2. A treatment cascade that tracks the care of established patients. 3. A detailed description of cascade methodology addressing cascade construction, including data sources and approaches to verifying patients presumed to be lost-tocare. 4. An improvement action plan that analyzes gaps in care that come to light through construction of the cascades, and outlines the organization s approach to remedying these gaps through QI activities.

8 All patients matter differentiating active and open caseloads Open caseload: HIV+ patients who touched the facility. Active caseload: HIV+ patients who received services in the HIV program. Exclusions: Patients who have died, are incarcerated or who have been confirmed to be in care outside the organization.

9 Organizational cascade measures Old linkage to care measure: Within 30 days New linkage to care measure: Within 3 days if linked internally, 5 days if linked externally

10 Percentage of patients Open caseload % 100% Definition: Number of patients, regardless of age, with a known diagnosis of HIV who received services anywhere in the organization whether routine, urgent, or emergent during the measurement year. 75% 60 65% % Open Active On ART Virally suppressed Undetectable

11 Percentage of patients Active caseload % 100% Definition: Number of patients, regardless of age, with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year % 60 65% % Open Active On ART Virally suppressed Undetectable

12 Percentage of patients Prescription of antiretroviral therapy % 100% % Definition: Proportion of patients from the active 65% caseload that were prescribed ART during the measurement year % Open Active On ART Virally suppressed Undetectable

13 Percentage of patients Viral load suppression % 100% % 65% Definition: Proportion of patients from the active caseload with a viral load <200 copies/ml at last 45% viral load testing during the measurement year Open Active On ART Virally suppressed Undetectable

14 What happened to the retention measure?

15 The anatomy of an effective cascade A good cascade is one that, above all, enables organizations to generate data that are locally relevant, timely, and actionable.

16 Hudson River Health Care: Institutional cascade of HIV care

17 Hudson River Health Care: Hudson Valley

18 Hudson River Health Care: Suffolk County

19 Hudson River Health Care Area of Focus: Viral load suppression

20 Hudson River Health Care: viral load suppression project Standardized lab review process Adherence education script Referral to intensive Retention and Adherence Program (RAP) 82% suppressed in 9 months Case manager present at medical visit Replicate RAP in other sites

21 NYP cascade measures

22 NYP institutional cascade

23 NYP HIV clinic cascade

24 NYP closing the gaps Pilot interventions to first close gaps in HIV clinic o Notification of all positive HIV test results at NYP to facilitate linkage of newly diagnosed patients o Working with navigators in ED and inpatient for real-time linkage of PLWH not engaged in care o Development of care plans for virally unsuppressed patients in multidisciplinary care teams Take lessons learned from pilot to help inform institution-wide interventions to close gaps

25 End goal? Accelerate improvement.

26 Part II: ehivqual Measures By March 31, 2017, clinics will be expected to submit data on: ART prescription Viral load suppression STI screening and appropriate treatment (syphilis, gonorrhea, chlamydia) THAT IS IT.

27 Part III: HIV tobacco cessation improvement campaign Goals: Tobacco is the leading cause of death in PLWH Promote tobacco screening and tobacco cessation for all patients living with HIV in NYS Expectations: Provider enrollment in campaign on website. Quarterly reporting on six tobacco cessation measures Reporting Period Report Submission Due January 1, 2017 March 31, 2017 April 30, 2017 April 1, 2017 June 30, 2017 July 31, 2017 July 1, 2017 September 30, 2017 October 31, 2017 October 1, 2017 December 31, 2017 January 31, 2018

28 HIV tobacco cessation improvement campaign measures 1. Screen 2. Intervene 3. Quit 1.1 Tobacco Cessation Screening The percent of HIV-infected patients who were screened for tobacco use. 2.1 Tobacco Cessation Counseling The percent of HIVinfected patients screened and identified as tobacco users who received a documented tobacco cessation counseling intervention. 2.2 Tobacco Cessation Pharmacotherapy The percent of HIVinfected patients screened and identified as tobacco users for whom tobacco cessation pharmacotherapy was prescribed. 3.1 Reduction in Tobacco Use The percent of HIV-infected patients screened and identified as tobacco users who selfreported reduced tobacco use Day Quit The percent of HIVinfected patients screened and identified as tobacco users who abstained from using tobacco for at least a consecutive 7-days during reporting period Day Quit The percent of HIVinfected patients screened and identified as tobacco users who abstained form using tobacco for at least a consecutive 30-days during reporting period.

29 Part IV: Stigma survey What? Adapted Health Policy Project Measuring HIV Stigma and Discrimination Among Health Facility Staff: Comprehensive Questionnaire by stigma subcommittee Stigma reduction toolkit provided to assist in education and ideas for programming Who? Administer survey to a wide-range of staff (i.e. not only providers) Review results with staff and come up with action plan to reduce stigma When? Return summary report by March 31, 2017

30 Components of healthcare staff stigma survey 1. Background Information Collecting demographics 2. Health facility environment and health facility policies Questions on practices and experiences in the health facility Questions on facility policy and work environment 3. Opinions about people living with HIV Attitudes and willingness to care 4. Questions on key populations MSM, Transgender and Gender Non-Conforming Patients, Women, People with a Mental Health Diagnosis, People of Color

31 Consumer Views Are people receiving services in the organization experiencing stigma? How will you answer this question?

32 Questions?