Quality Management Update Ryan White Part A Atlanta EMA January 5, 2017
Agenda Program Monitoring Site Visits Desk Audits Quality Projects CAREWare Project Time-Study Project Quality Measures HAB Performance Measures EMA Performance Measures
Program Monitoring Quality Assurance - Refers to a broad spectrum of evaluation activities aimed at ensuring compliance with minimum quality standards Programmatic Site Visits Fiscal Programmatic Quality Management Desk Audits or Chart Reviews Review of Client Records
FY 2016 CHANGES Decrease Site Visits Quarterly Annually Expand Quality Management Discussion During Site Visits Increase Scope and Volume of Chart Reviews In addition to eligibility, reviewing charts for compliance in each funded service category Random sampling based on client size Annually quarterly, ongoing
QM SITE VISITS
QM Site Visits Infrastructure Quality Management Plan Quality Improvement Projects
QM Site Visits- Infrastructure Quality Management Staff Capacity Full-time QM Coordinator 29% Part-time QM Coordinator 65% QM Team Meeting Frequency Weekly 6% Monthly 35% Quarterly 47% Biannually 12% QM Team Size 1-3 Members 12% 4-6 Members 35% 7-9 Members 24 % 10+ Members 29%
QM Site Visits- QM Plan Common elements that were missing or vague: Quality Infrastructure Roles/Responsibilities Goals and Objectives SMART Objectives in alignment with goals Performance Measurement Process Participation of Stakeholders Capacity Building QI Projects Evaluation Process to evaluate QM Program QM Plan Implementation
QM Site Visits- Projects QI Projects 12% 6% 29% 18% 35% none 1 2 3 4+ Subject # projects # agencies Care Continuum 13 10 Core Services 8 5 Administrative 6 6 Technology 6 4 Client Satisfaction 5 5 HAB Measures 5 3 Support Services 4 2 Workflows 3 2 Capacity Building 2 2
CHART REVIEWS- 2 ND QUARTER
Desk Audits (Chart Review) Conducted by Project Officers New Chart Review Tool- created Summer 2016 Chart Review tool is based on language from: National Monitoring Standards for Ryan White Part A Grantees: Program Part A
Chart Review 2016 % of Sample* 100% 25-50% 10% 3-5% Number of Clients Served (Range) 1-50 unduplicated clients 51-100 Unduplicated Clients 101-999 Unduplicated Clients 1,000 Unduplicated clients or more Reviews a random sample of client records based on projected client size Sample Size - 1,985 Chart review visits started at the end of Quarter 2 Status- Completed 685 chart reviews
Chart Review 2016- Status Funded Service Categories Sample Size Percentage Completed Medical Case Management 118 16% Medical Nutrition Therapy 55 31% Mental Health 155 43% OAHS-Primary Care 643 41% Oral Health 213 12% Substance Abuse 76 53% Childcare 28 0% Food 159 31% Legal 15 100% Linguistics 32 22% Medical Transportation 70 100% Non-Medical Case Management 284 23% Psychosocial 137 24%
Chart Review Summary Some findings included: Eligibility Some files were not recertified within timeframe SSI amount not listed on letters Lack of HIV Documentation Missing supporting documentation for residency and income claims OAHS Clinical notes were not signed by a provider Mental Health Treatment plan were not signed by a provider Missing documentation of the existence of a detailed treatment plan for each eligible client that includes ALL of the following: (1)Diagnosis of mental illness condition, (2) Treatment modality (group or individual), (3) Start date of mental health services, (4) Recommended # of sessions, (5) Date of reassessment, (6)Any recommendations for follow-up, and (7) The signature of the mental health professional rendering services is documented
QUALITY IMPROVEMENT PROJECTS
CQI Projects CAREWare Project Time-Study Project
CAREWare Project: PDSA Cycles PDSA Model Cycle 1: Data Verification Cycle 2 : Computer System Optimization Cycle 3: Data Entry and Reporting Processes Is CAREWare data entered the same across the EMA? Are CAREWare data report parameters set for data of interest?
CYCLE THREE: Data Entry and Reporting PLAN Develop CAREWare Survey based on subservice categories DO Distribute surveys during site visits Meet with Cross-parts representatives about updating CAREWare dictionary STUDY Summarize and Analyze Results Discuss results with Part A, B, C, and D representatives to identify areas of needed clarity and training Follow-up with agencies to better understand data entry processes and usage Review CAREWare setup with developers for ideal data parameters to improve how data is entered and shared
STUDY: CAREWare Survey Which subservice fields should be added, edited, or removed? Based on services currently provided, how should we define Units? Subservice category? Which subservice fields are needed to calculate a quality measure? Reviewing survey responses for Most utilized Least utilized Variations in usage
STUDY: CAREWare Survey Outpatient Ambulatory Health Services Medical Procedure Visit Primary Care Visit Routine HIV/TB Primary Care Visit Medication Pick up Primary Care Prescription (nonhiv med) Lab Review Oral Health Alternative Units Cost of procedure Unit per quadrant Medical Case Management Discharge Linkage Treatment Adherence Individual Medication Adherence Counseling Medication Adherence Assessment Case Management Assessment Medical Nutrition Therapy Nutritional Assessment Nutritional Supplement Mental Health and Substance Abuse Intake Assessment Intake/Assessment Treatment Plan Behavioral Health Screening
STUDY: CAREWare Survey ChildCare No Variation Food Bank/Home Delivered Meals Vouchers Legal No Variations Linguistics American Sign Language Other Language NonMCM Benefits/Financial Counseling Face-to-Face Interim Contact Update Service Plan-Non Medical Medical Transportation Van Public Transportation 58% use one-way trip Psychosocial Support Default Psychosocial Support 2 Group Peer Counseling HIV Support Group
Time Study Project: Cycle One Plan Determine the best way to gather information related to appointment data Ensure the study takes place during a representative time period
Next Steps CAREWare Project STUDY Discuss results with crossparts Follow-up with agencies Act Revise CAREWare Data Definitions with Parts B,C, and D Distribute and train Quality Management and Data Designees Customize CAREWare Time-Study Project Create data collection tool
QUALITY MEASURES
HAB MEASURES- 11.30.16 HAB Performance Measure Part A Core01 HIV viral load suppression 74% Core02 Prescription of antiretroviral therapy 89% Core03 HIV medical visit frequency 62% Core04 Gap in HIV medical visits 15% HAB03 CD4<200 with PCP prophylaxis 38% HAB07 Cervical Cancer Screening 27% HAB09 Hepatitis C Screening 76% HAB10 HIV risk counseling 80% HAB12 Oral Exam 24% HAB13 Syphilis screening 72% HAB14 TB Screening 87% HAB15 Chlamydia Screening 75% HAB16 Gonorrhea Screening 75% HAB17 Hepatitis B Screening 73% HAB21 Mental Health Screening 73% HAB23 Substance Use Screening 72%
EMA MEASURES- CORE 11.30.16 EMA Performance Measure Target Part A OAHS: Viral Load Suppression 83% 74% OAHS: Medical Visits Frequency 83% 62% Oral Health: Medical Visits Frequency 96% 76% MNT: Medical Visits Frequency 96% 73% MNT: Referred received MNT screening, education or counseling visit N/A MCM: Medical Visits Frequency 53% 57% MCM: Care Plan N/A MCM: Viral Load Suppression 66% MCM: Gaps in Medical Visits 23.31% Mental Health: Medical Visits Frequency 90% 65% Mental Health: Screening (HAB 21) 83% 73% Mental Health: Treatment Plan N/A Substance Abuse: Medical Visits Frequency 92% 64% Substance Abuse: Treatment Plan N/A
EMA MEASURES- Support 11.30.16 EMA Performance Measure Target Part A Non-MCM: Medical Visits Frequency 86% 66% Non-MCM: Care Plan N/A Non-MCM: Viral Load Suppression 88% 72% Non-MCM: Gaps in Medical Visits 13.30% Food Bank/ Home Bank: Medical Visits Frequency 85% 56% Food Bank/ Home Bank: Dietitian Review N/A Psychosocial Support: Medical Visits Frequency 71% 57% Psychosocial Support: Linkage to Care N/A Medical Transportation: Medical Visits Frequency 86% 60% Legal: Medical Visits Frequency 75% 53% Linguistics: Medical Visits Frequency 96% 83% Child Care: Medical Visits Frequency 96% 65%