Sept. 20, 2012 3:00—4:30 PM Successes in the Field – NQC Fellowship Program

Sept. 20, 20123:00—4:30 PM

Successes in the Field – NQC Fellowship Program

National Quality Center (NQC)2

What does the fellowship involve?

• Mentorship from the NQC/HRSA consultants• Conference calls among the fellows• Webinars on topics you will choose• Site visit(s) supported by your mentor

To support you as you carry out:• Field study: enriching the practice of quality

among Ryan White grantees• QI project: on a process that matters in your

own organization

Fellowship Experience 2011-2012

Julia Schlueter, MPHWashington University School of Medicine


Projects

• Local Syphilis screening 2x a year, at least 3 months

apart at Washington University School of Medicine’s Adult ID clinic

• National Interest Project (Field Study) in+care Campaign

• Site Visits with Mentor

Local Project


Successes

• Client’s last screening date and result added to weekly distribution list that nurses review

• Physician champion went to individual clinic sessions (At start of project and again in July)

• Lab now stays open during lunch• Developed an algorithm for syphilis treatment

Increased syphilis screening 2x a year from 36% in 2010 to 62% in 2011


Challenges

• Buy-in from providers

• Rapid change and PDSA cycles – things moved a bit slower!

• Competing priorities for QI projects

National Project


• Planning Committee Weekly conference calls Input on campaign name, website, webinars topics,

logo/design logistics

• Website Provided feedback on outline, templates Helped to write biographical sketches

• Newsletter Journal article reviews Provider Spotlights

Site Visits


Site Visits

• Completed with Mentor – Barbara Rosa• 3 Ryan White agencies

USC – MCA (CA) LAFAN (CA) MIHS (AZ)

• Participated in planning process and facilitation of site visit

• Observe mentor in action!


Site Visits - Successes

• Being part of planning process• Understanding goals of organization for TA and

mentor’s goals• Fellow leading activity and getting feedback from

mentor• Ability to observe different methods and tools

consultant uses for common QI issues• Observing multiple site visits• Concentrated one-on-one time with mentor to solely

focus on QI


Site Visits – Common Themes

• Communicate about QI Transparency is key!

• Supervisors need QI training• Create a culture of QI• Enthusiasm for QI exists, staff need direction• Clearly defined Quality Manager’s role• Make the QI processes sustainable• Cross Training – Kathleen’s Noah’s Ark rule

NQC FELLOWSHIP 2011-2012

Claudia Medina, MD, MHA, MPH


PROJECTS

- Local Project- Viral Suppression – local agency but it became a Network effort

developing in

- Bring up to speed the Quality Management program for the Ryan White Part D Louisiana Network ( 10 Agencies – 4 cities)

- National Interest Project- Integration of Quality Management tools, applications and

dissemination through the Latino Commission on AIDS and their workshops.


LOCAL PROJECT


RETENTION IN CARE 64.28%

VL < 20067.08%

VL < 4849.07%

OBJECTIVE:INCREASE INDICATORS BY 20% IN THE NEXT 12

MONTHS

SUCCESSES


SUCCESSES

Performance_Measure Jul-11 Part D Jul-12 GOAL

CD4 44% 62% 75%

Viral Load 42% 61% 75%

MV 64% 72% 80%

HAART IN AIDS 65% 78% 90%

PCP Prophylaxis 22% 50% 75%

ARV Pregnancy 49% 96% 95%

Neonatal AZT 42% 79% 95%

PCR Exposed 32% 57% 95%

CD4

Viral Lo

ad

MV

HAART IN AIDS

PCP Prophyla

xis

ARV Pregnan

cy

Neonata

l AZT

PCR Exposed

0%

20%

40%

60%

80%

100%

120%

How are we doing?

Jul-11Part D Jul-12GOAL


CHALLENGES

- Part D funds % of salaries of physicians and nurses across the State. This makes it very difficult when it comes to decide how much data is Part Ds or how much belongs to another funding.

- Part D has 3 medical case management agencies without primary care on site. Nurses work at the community level but they are responsible for collecting clinical data with evidence.

- LA has 64 parishes and Part D covers population in 50% of them.

SNAPSHOT

Total clients served 2036 100%

# of active clients at the end of the reporting period1753 86%

# of clients shared within the network 326 16%

# of clients enrolled in the reporting period 794 39%

# of clients closed in the reporting period 360 18%

of clients enrolled in the reporting period that where also closed

161 20%

PART D OVERVIEW FOR THE FY JULY 2011 – JULY 2012


NATIONAL PROJECT


WHY I CHOSE THIS?

• Latinos make up for 16.3% of total USA population.• Latinos represent 18% of HIV cases. • At some point in life:

1 in 36 Latino/Latino men will be diagnosed with HIV. as well 1 in 106 Latino/Latina women.

• Many factors contribute to the epidemic of HIV in Latinos.• Latinos have poorer knowledge of HIV and treatment than whites.• When hospitalized for HIV/AIDS Latinos are less likely to receive

optimal care. • Poor and less educated patients are more likely to have less

effective communication……….


Improvement is Possible!!!

• Quality improvement efforts have resulted in the reductions of other chronic disease disparities.

• A target intervention within a quality improvement culture may offer important lessons in disparity reduction.

• Programs that work with HIV-infected Latino population require culturally cultural and linguistically relevant interventions.


THE PROPOSAL

• Was to bring quality knowledge to the Latino providers and the communities across the nation through cultural competence education.

• To collaborate between The National Quality Center and the Latino Commission on AIDS.

• The purpose of this joint effort was for the National Quality Center to train the staff of the Latino Commission on AIDS on quality methodologies and tools.

• The Latino Commission staff was going to incorporate the message of quality in their programs and help spread the word across the nationwide organizations that provide services to the HIV Latino community.


REALITY

SUCCESSES CHALLENGES

We were able to communicate with the director of the LCA

Keep up with the LCA agenda

We identify two LCA leaders and trainers

Continuity in Training

We train two LCA staff at the TOT meeting in November 2011

Different MISSIONs (political/ quality)


LESSONS LEARNED• Concentrated time to think, breath, and do ONLY QUALITY• Opportunity to study and learn more about theory and application.• Great opportunity for networking in Quality.• Shared and built a network of colleagues/peers in the quality world;

reduced isolation• Opportunity to enhance communication and presentation in quality.• Learn from the experts (mentors, facilitator)• Quality is much more than improvement projects, it is a life style.• Learned so much about the theory and application of quality• Broadened perspective of QI – looking at quality in the broader

healthcare field, not just Ryan White• The fellowship opened opportunities for professional development:

HIT Certification CPHQ….


Fellowship – Lesson Learned

• Learn from the experts• Concentrated time to focus on QI • GROWTH!• Built a network of peers in the quality world – reduced

isolation• Learned so much about the theory and application of

quality• Networking• Broadened perspective of QI – looking at quality in

the broader healthcare field, not just Ryan White• Professional development - including CPHQ

Documents

Sept. 20, 2012 3:00—4:30 PM Successes in the Field – NQC Fellowship Program