New Jersey Family – Centered HIV Care Network

Lead Agency New Jersey Department of Health

Mission- provide comprehensive, culturally sensitive, coordinated care for women, infants, children, youth and families with HIV infection

Network offers HIV specialty care, medical case management, access to clinical drug trials, social service support, outreach, counseling and testing, and family case management

2,498 Part D clients were served in 2012 The Part D Statewide Network consists of 7 HIV clinics and their satellites sites; Cooper Hospital, Camden; The FXB Center, Newark; Jersey City Medical Center, Jersey Shore Medical Center, Neptune; Newark Beth Israel Hospital, Robert Wood Johnson Medical School, New Brunswick; St. Joseph’s Hospital and Medical Center, Paterson

Ellen Dufficy, Nurse Consultant NJ Ryan White Part D609-777-7795

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QI Project: Pap Screenings

Team Members: Multiple disciplines from all 7 Network agencies and consumers

Problem Statement: The 2012 Network rate for annual Pap screens for all HIV+ patients over the age of 18 is 83%, which surpasses the Network quality benchmark rate of 75%. However it does not meet the IHI national quality benchmark rate of 90%. This indicates that the Network needs to further improve upon Pap screening rates to achieve the national standard. Although the Network’s average has surpassed the Network goal, as we drill deeper into the data only two of the seven Network sites individually met or surpassed the 75% rate. In addition, the 2012 Network rate reaches only 65% when calculated using the electronic database rather than through the use of on-site chart reviews.

Goal: By February 28, 2014, the Network will realize a 75% rate for Pap screens at each of the seven sites, when calculated via an on-site chart review or the site’s electronic database.

HAB HIV Core Clinical Performance Measure: Percentage of women with HIV infection who have a Pap screening in the measurement year

Meet with Gyn clinic staff and consumer QI representative to develop plan to better engage women with HIV in Gyn care through better service coordination efforts

Save 4 open Gyn slots twice a week for walk-ins from the HIV clinic. Schedule those women who need Paps for those time slots at HIV clinic. Upon arrival at HIV clinic, walk patient over to Gyn clinic for a Pap, then return them to the HIV clinic for the HIV exam

Note the number of women each week who get a Pap. Compare these data to weekly average before intervention. Note any barriers or reasons why women still do not access Gyn care

As intervention proves to be successful, use consumer advocates instead of HIV staff to walk patients through both clinics

Plan

Do

Study

ActProblem Statement: The Pap rate for women 18 years of age and older is lower than the expected standard of care. Although women are routinely referred for Gyn care, they do not keep appointments

Strategy: Use a multidisciplinary team approach that crosses Parts, utilizes collaboration and includes consumers, to optimize scheduling flexibility and remove patient barriers to access to Gyn care

NJ participated in HAB/NQC Quality Management Learning Collaborative in 2008 NJ Cross Part Collaborative initiated October 2008 Formed multidisciplinary group across Parts, began to look comprehensively at HAB

measures. Three 18 month phases of Network data have been collected and reviewed by the Network through PDSA cycles

Methods and Tests

Sample PDSA cycle

MeasuresThe Network will realize a 75% Pap rate at all 7 sites

Feb12 April 12

June 12

Aug 12 Oct 12 Dec 12 Feb 13 April 13

June 13

0

20

40

60

80

100

59 53 55 55 59 63 64 65

Part D Network Electronic Data: Pap Screening

Pap Screening

Percent

2006 2007 2008 2009 2010 2011 20120

20

40

60

80

100 95

7266

7871

80 83

Part D Network Chart Audit Data: Pap Screening

Pap Screening

Percent

February 2012- April 2013 Phase 3 cycle reports, RWPD Network aggregate data abstracted from electronic systems. June 2013 data report remains pending at this time.

June 1- May 31 annual chart audit RWPD Network aggregate reports

Results Although improved Pap rate to 65%, not quite

where we need to be yet Network agencies demonstrate strong commitment

to continue the project, including AETC provider training for on site Paps

Phase 4 of CPC will convene in June 2013 and Pap is likely to remain the QI focus for Part D Network and CPC

2010 Part D Pap rate 44%

2011 Part D Pap rate 62%

2012 Part D Pap rate 65%