Utilizing CQI to Improve the Health of Supportive Housing Residents The North American Housing and HIV/AIDS Research Summit VII September 25-27, 2013 Montréal, Canada
MISSION To provide 100% access to quality HIV/AIDS care for all our clients, regardless of race, socioeconomic status, or sexual orientation; To ensure that each of our clients remains connected to treatment and obtains the best possible health outcomes; To provide quality HIV prevention, housing, and care services in a safe and nurturing environment; To unite Harlem s diverse communities and address the needs of all people living with and threatened by HIV/AIDS; To empower our clients physically, emotionally, socially, and spiritually. HISTORY Founded at the height of the AIDS epidemic in 1988, Harlem United was part of a community-based movement to care for PLWHA and address: The lack of response from established providers; The unique personal, social, and institutional barriers to care; The intersecting needs of people living with HIV/AIDS who were homeless, and/or suffering from mental illness and/or substance abuse.
Integrated Health Services Structure HIV/AIDS Treatment & Support Services Community Health Services 586 Units of Supportive Housing Adult Day Health Centers Food & Nutrition Health Home Holistic Provider-Led, Patient-Centered Primary Care and Dental Services Mental Health Services Patient Navigation/Case Management Support Community Based HIV/STI/HCV Testing & Prevention Services Linkage to Care & Treatment Substance Use Services (Syringe Access, Harm Reduction, Recovery Readiness). HOME (Helping Our Members Evolve) Space Integrated Interventions for MSM of Color
Permanent Housing 392 Scattered Site 53 Congregate 586 Units of Housing Transitional Housing 117 Scattered Site Emergency Housing 24 Congregate
Management Approach
Management Approach CQI: Program-level assessment of service delivery, testing and implementation of quality improvement activities Administrative Data-driven supervision: Staff-level assessment (broad) of service delivery Clinical Supervision: Staff-level assessment (focused), clinical skills building and trainings
Data Driven Supervision Involves individual and group supervision and monthly chart auditing to ensure that each staff is providing appropriate services to clients in a consistent and timely manner within the different housing programs. Administrative supervisors meet with their staff to provide feedback and support whenever problems are identified among individual staff.
Clinical Supervision Involves individual and group supervision, monthly chart auditing to assess the quality of clinical documentation, live assessment of clinical skills, and focused trainings to evaluate staffs current skill levels, facilitate skills development, and ensure that clients receive the highest level of care.
Continuous Quality Improvement Involves monthly data extraction from client charts to evaluate whether service targets are being met within programs and across the Housing Division. The Evaluator works closely with staff of each housing program to problem-solve around any service targets that are not being met through action plans or PDSAs.
Funder Indicators % of successful home visits within the last month % of Reassessments completed within the last 120 days % of Treatment Plans completed within the last 120 days Agency Indicators % of clients with a PCP visit in the last 180 days % of clients with CD4 count over 200 % of clients with ER visit within the last full month % of clients hospitalized within the last full month Program Indicators % of clients with case conferences % of clients adherent to ARV medication % of clients referred to Health Home
Process Evaluation and PDSA
Section II: Harlem United Indicators Evidence that client has seen primary care provider within the last 120days Month Jul. 2012 Aug. 2012 Sep. 2012 Oct. 2012 Foundation House West CQI Results Foundation House East CQI Results # / Sample Percent # / Sample Percent 22/23 25/25 23/25 22/24 97% 100% 92% 92% 26/29 26/28 26/28 26/28 90% 93% 93% 93% Total 92% 96% 92% 92% Documented CD4 and Viral Load results within the last 120 days Jul. 2012 Aug. 2012 Sep. 2012 Oct. 2012 19/23 21/25 19/25 20/24 83% 84% 76% 83% 17/29 22/28 22/28 21/28 59% 79% 79% 75% 69% 81% 77% 79% Clients with CD4 below 200 Jul. 2012 Aug. 2012 Sep. 2012 Oct. 2012 7/23 7/25 8/25 4/22 30% 28% 32% 18% 9/29 7/28 7/28 6/28 31% 25% 25% 21% 31% 26% 28% 20% Clients with undetectable Viral Load Jul. 2012 Aug. 2012 Sep. 2012 Oct. 2012 20/23 21/25 20/25 20/24 87% 84% 80% 83% 24/29 26/28 26/28 25/28 83% 93% 93% 89% 85% 89% 87% 86% Pap smear and pelvic exam: 1 per last 365 days Jul. 2012 Aug. 2012 Sep. 2012 Oct. 2012 1/3 3/4 4/4 3/4 33% 75% 100% 75% 5/9 7/12 6/11 6/11 55% 58% 55% 55% 50% 62% 67% 60% Comprehensive dental screening/exam within the last 6 months Jul. 2012 Aug. 2012 Sep. 2012 Oct. 2012 9/23 8/25 7/25 8/24 39% 32% 28% 33% 10/29 11/28 11/28 10/28 34% 39% 39% 36% 36% 36% 34% 35%
HRSA HAB Performance Measures January 2011 Indicator Dental and Medical History Dental Treatment Plan Oral Health Education Periodontal Screening or Examination Phase 1 Treatment Plan Completion How Measured Percentage of HIV-infected oral health patients who had a dental and medical health history (initial or updated) at least once in the measurement year Percentage of HIV-infected oral health patients who had a dental treatment plan developed and/or updated at least once in the measurement year Percentage of HIV-infected oral health patients who received oral health education at least once in the measurement year Percentage of HIV-infected oral health patients who had a periodontal screen or examination at least once in the measurement year Percentage of HIV-infected oral health patients with a Phase 1 treatment plan that is completed within 12 months
40% Clients with Oral Health Visit in last 6 months 30% 20% 10% 0% Oct. 2012 Nov. 2012 Dec. 2012 Jan. 2013 Feb. 2013 Mar. 2013
50% Clients with Oral Health Visit in last 6 months 40% 30% 20% 10% 0% Apr. 2013 May 2013 Jun. 2013 Jul. 2013 Aug. 2013 Sep. 2013
Outcome Evaluation
100% 90% 90% 80% 70% 73% 60% 50% 40% 30% 20% 10% 0% PCP within 180 days (n=530) Suppressed Viral Load (n=418)
Thank you! Contact Info: Kevin Rente- Krente@harlemunited.org Monika Grzeniewski- Mgrzeniewski@harlemunited.org