Clinical Quality Management Program. April 25th, 2018 Katie Cobb & K.C. D'Onfro Senior Quality Management Coordinators Ryan White Services Division

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1 Clinical Quality Management Program April 25th, 2018 Katie Cobb & K.C. D'Onfro Senior Quality Management Coordinators Ryan White Services Division 1

2 Learning Objectives Epidemiological profile of the EMA/Part A PCN and CQM Plan Infrastructure Objective (CQM Committee) Performance Measure Objective Quality Improvement Objectives Next Steps 2

3 Data Sources 3

4 Total # of Cases Epidemiologic Profile of the Boston EMA People Living with HIV (PLWH) by Year As of 12/31/2015, there were 17,259 PLWH/A in the Boston EMA Year 5,204 Part A Clients 4 MA data exclude individuals diagnosed while incarcerated Source: MDPH, NHDHHS as of 12/31/2016

5 People Living with HIV By County 5

6 Boston EMA - PLWH in 2015: Race/Ethnicity Black (non-hispanic) and Hispanic/Latino residents account for 8% and 10% of the Boston EMA population respectively, but accounted for 32% and 26% of new HIV cases in 2015 % new cases of HIV 1% 4% 26% 32% 36% % total population living in EMA 2% 6% 8% 10% 74% 0% 10% 20% 30% 40% 50% 60% 70% 80% White Black Hispanic Asain Other 6 MA data exclude individuals diagnosed while incarcerated Source: MDPH, NHDHHS, 2010 Census Data as of 6/1/2017

7 Boston 2016 Cases: Risk Exposure 300 # of Incident Cases by Exposure MSM IDU Heterosexual Sex Presumed heterosexual Unknown MA data exclude individuals diagnosed while incarcerated Source: MDPH, NHDHHS as of 12/31/2016 7

8 Outcomes of PLWH/A accessing Part A services 100% HIV/AIDS Patients in clinical care on ARTs 100% Undetectable Viral Load in the Boston EMA 99% 99% 95% 98% 97% 97% 97% 97% 90% 85% 84% 86% 87% 96% 80% 95% % Source: JSI Clinical Chart Review Source: e2boston as of 4/18/18 8

9 Care Continuum 9

10 Summary of Epi data What are we doing well? Viral suppression rate of 87% Amount of people on ARTs is also high Wide range of direct and support services offered throughout the EMA Where can we improve? Black and Latino populations have a disproportionately high risk of contracting HIV Black and Latino MSM Black and Latina heterosexual women IDU Long term survivors 10

11 Definitions Quality Assurance A broad spectrum of activities aimed at ensuring compliance with minimum quality standards Quality Improvement A deliberate process to continuously improve efficiency, effectiveness, equity, and satisfaction in the current system Clinical Quality Management Program The coordination of activities aimed at improving patient care, health outcomes, and patient satisfaction among PLWH/A 11

12 Clinical Quality Management (From PCN-15-02) 12

13 Components of a CQM Program Quality Improvement Infrastructure Performance Measurement 13

14 CQM Program Plan Goal: To increase viral suppression among PLWH/A in the Boston EMA from 87% to 90% by 2020 Objective 1:Support a CQM Committee that develops the CQM Plan and corresponding activities Objective 2:Develop a portfolio of performance measures, maintained by the CQM Program that are meaningful to subrecipient providers and PLWH/A Objective 3: 100% of subrecipient providers will be engaged in at least one quality improvement project within the fiscal year that is focused on improving health outcomes, consumer care, or consumer satisfaction among PLWH/A 14

15 Objective 1: Infrastructure: CQM Committee Mission: "To guide, advise, and provide feedback on all aspects of the Ryan White Services Division Clinical Quality Management Program" 15

16 Objective 2: Performance Measures Relevant Improvable Measurable (through E2Boston) Can be tracked quarterly Related to Patient Care, Health Outcomes, or Patient Satisfaction 16

17 Objective 2: Performance Measures FY18 Performance Measures Service Category Medical Case Management Medical Case Management Non-Medical Case Management Oral Health Oral Health Foodbank/ Home Delivered Meals Psychosocial Support Medical Transportation Residential Substance Abuse Housing Medical Nutrition Therapy Performance Measure Viral Suppression Gap in Medical Visit Frequency Linkage to Care Retention in Dental Care Dental Care Client Satisfaction Access to Support Network Gap in Medical Visit Frequency HIV Medication Adherence Client Satisfaction Client Satisfaction 17

18 % Patients Virally Suppressed Objective 2: Data Display Information 100% Viral Suppression Rates among Agencies who Provide Medical Case Management Services Agency 1's Viral Suppression 95% 95% 90% 85% 80% 75% 70% 65% Average Goal 90% 85% 80% 75% 70% 60% 55% 50% % Q1 Q2 Q3 Q4 Agency 18

19 Objective 3: Quality Improvement Vision By The end of Fiscal Year 2020, every provider will be engaged in at least one Quality Improvement Project aimed at improving Health Outcomes, Patient Care, or Patient Satisfaction 19

20 Objective 3: IHI Model for Improvement 20

21 An Example: Harbor Health Services Goal: Improve Viral Suppression What are we trying to Increase Viral Suppression Rates from 85% to 90% in 3 months (December accomplish? 2017) How will we know a 1. Increase in Viral Suppression Rates change is an improvement 2. Reduction in the percentage of patients with no lab work What change can we make that will result in improvement? 1. Present Drill Down Data in HIV PCC meeting and carefully evaluate those patients who are not virally suppressed. PLAN: 2. Develop an Individual plan for each patient who is not virally suppressed or who is missing lab data and implement this plan. 3. Add any patients who are not virally suppressed to the Highest Risk Registry. Between September and December 2017: Providers, Case Manager, ID Clinical DO: Care Specialist, and Nurse tested the above ideas with different patients After 3 months, the team observed the following changes STUDY: ACT: 1. Viral suppression rates increase from 85% to 92% 2. Patients without lab work reduce from 4% to 1% The changes were adopted because the team liked results. 21

22 Quality Improvement Resources 22

23 Next Steps Introduction to Quality Improvement (This afternoon ) Quality Improvement Culture Assessment (June 2018) Data Displays/ News Letters (July 2018) Opportunities for Continued Training and Technical Assistance (Ongoing) 23

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