Engaging Stakeholders Through Quality Management National Latino - PowerPoint PPT Presentation

Engaging Stakeholders Through Quality Management National Latino HIV and HCV Conference – San Antonio, TX May 19, 2018 1 1

Disclosures The presenter has no financial relationships to disclose. 2 2

Learning Objectives  Describe the framework for clinical quality management in HIV programs  Use available performance measurement data to identify disparities in HIV care using an evidence-informed tool  Identify evidence-informed improvement interventions appropriate to improve health equity leveraging stakeholder input  Use available performance measurement data for public relations and marketing purposes 3 3

Clinical Quality Management Framework Policy Clarification Notice 15-02 4 4 Organizational Ideas, LLC

HRSA-HAB Policy Clarification Notice 15-02  The HIV/AIDS Bureau’s requirements regarding clinical quality management based on the Ryan White HIV/AIDS Program legislation  Applies to recipients of all Parts funding and their subrecipients  The focus is on improving HIV health outcomes  Available at: https://hab.hrsa.gov/sites/default/files/hab/clinical- quality-management/clinicalqualitymanagementpcn.pdf 5 5 Organizational Ideas, LLC

Components of a CQM Program  CQM programs coordinate activities aimed at improving patient care and patient satisfaction to drive health outcomes improvement  CQM activities should be continuous and fit within and support the framework of grant administrative functions  Components of a CQM program 1. Infrastructure 2. Performance measurement 3. Quality improvement 6 6 Organizational Ideas, LLC

Grant Administration  Grant administration refers to the activities associated with administering a RWHAP grant or cooperative agreement  The intent of grant administration is not to improve health outcomes. Therefore, they are not CQM activities Grant Administration ≠ Clinical Quality Management 7 7 Organizational Ideas, LLC

Examples – Grant Admin vs. CQM  Grant Administration  Clinical Quality Management  Creating a performance  Creating a sophisticated measurement system to collect performance measurement system minimum data required by the to collect service data tied to HIV RWHAP legislation and HAB health outcomes  Creating care systems and service  Tests of change to improve care, standards systems, or standards  Management of mandated  Management of peer learning and reporting collaboration programs  Provider training geared toward  Provider training geared toward compliance improving HIV health outcomes (evidence-based/evidence- informed) 8 8 Organizational Ideas, LLC

Quality Assurance vs Quality Improvement Quality assurance:  Refers to a broad spectrum of activities aimed at ensuring compliance with minimum quality standards  Include the retrospective process of measuring compliance with standards  Part of the larger administrative function of a recipient’s program or organization and informs the CQM program Quality Assurance ≠ Quality Improvement 9 9 Organizational Ideas, LLC

Examples – QA vs. QI  Quality Assurance  Quality Improvement  Measuring compliance with  Continuously improving standards / Contract monitoring / performance beyond minimum Chart reviews service standards  Focused on individual “bad apples”  Focuses on health systems and processes  Responsibility of a few to carryout  Responsibility of all 10 10 Organizational Ideas, LLC

Performance Measurement Data The things you are already required to collect 11 11

Traditional Performance Measurement  HAB Performance Measures  Identifying core performance measures that are most critical to the care and treatment of people living with HIV  Combining performance measures to address people of all ages living with HIV  Promoting relevant performance measures used in other federal programs  Archiving performance measures that are no longer consistent with U.S. Department of Health and Human Services guidelines or applicable to the general population 12 12 https://hab.hrsa.gov/clinical-quality-management/performance-measure-portfolio

RWHAP Reporting Requirements  Ryan White Services Report  Network primary recipient requirements  ADAP Services Report  Dental Services Report 13 13 https://hab.hrsa.gov/program-grants-management/data-reporting-requirements-and-technical-assistance

Strategies for Enhanced Data Management  Data element and measures inventories  Use this to manage waste through duplicated reporting requirements (or slight differences)  Test for completeness and performance  Identify priorities for data cleaning and data collection process improvement  Drill down clinical measures included in required reporting using demographic and clinical data  Identify priorities for “story - telling” and QI 14 14

Data Element and Measures Inventories  Simple lists of all data elements and performance measures you need to collect  Include level of detail (e.g., is transgender T or is it MTF and FTM? What is the cut off for VS?)  Put it in excel so you can sort and filter  Double check for duplicates and NEGOTIATE!  Update data collection to include the MOST granular level wherever you land This is a Data Dictionary! 15 15

Data Element Completeness  Garbage in, Garbage out…  Where are there holes in the data?  Use excel to identify cross-sectional holes  What holes can be “padded”?  What holes can you live with and what ones do you need to fill to tell your story?  Work with patient and staff groups to identify ways to increase data completeness from both sides of the desk 16 16

Testing Performance Measures  Run all required performance measures and populate the results in a table like for the data element inventory  Ideally, populate a calculator or other tool that can be modified to answer questions you have about your data 17 17

Experience Data  Don’t forget our Quadruple Aim!  Improving patient outcomes  Improving patient experience  Decreasing costs  Joy in work (improving staff experience)  Experience data complements outcome and cost data and is important to the community you serve 18 18

Patient Experience  A measure of your patients’ morale  Red flags and important areas of investigation  Trends over time  Influences retention in care, health seeking behavior, patient attitudes toward staff  Can be responsible for poor retention in addition to patient population expansion (word of mouth travels fast)  Identifies areas of potential concern to community 19 19

Staff Experience  A measure of staff morale  Red flags and important areas of investigation  Trends over time  Influences the care provided and the environment where patients are treated  Can be responsible for downward spirals in addition to forward motion  Identifies areas of patient care, care environment and staff supports that require improvement  TRAUMA can affect your staff, too 20 20

Leveraging Data for Health Equity Using the data you already collect for noble purposes 21 21

Step 1 : Performance Measurement 22 22

You’re Already Doing It! 23 23

Health Disparity Calculator – Data Entry 24 24

Health Disparity Calculator - Analysis 25 25

Step 2 : Root Cause Analysis 26 26

5 Whys Analysis  The root cause is “the evil at the bottom” that sets in motion the entire cause-and-effect chain causing the problem(s)  Some root cause analysis approaches are geared more toward identifying true root causes than others; some are more general problem-solving techniques, while others simply offer support for the core activity of root cause analysis  By becoming acquainted with the root cause analysis toolbox, you’ll be able to apply the appropriate technique or tool to address a specific problem 27 27 http://asq.org/learn-about-quality/root-cause-analysis/overview/overview.html

Cause and Effect Diagrams 28 28 http://www.ihi.org/resources/Pages/Tools/CauseandEffectDiagram.aspx

Root Cause Analysis is Important!  Organizes and displays all causes and sub-causes that may influence a problem, outcome, or effect  Helps push people to think beyond the obvious causes, (money, time) to find some causes that they can fix/improve  Helps organize potential solutions and make clear who should be involved in solutions  Encourages a balanced view  Demonstrates complexity of the problem 29 29

Step 3 : Prioritize 30 30 Random House Webster’s College Dictionary

Simple Priority Matrix What is the How many Do you have the Is it reasonable Do you have Potential Projects potential patients will it support and achievable & Total Score the data? impact? affect? resources? feasible? VLS Retention Perinatal trans. Dental Pap These can be scored via scale “10” is the most positive response “1” is the least positive response 31 31 Organizational Ideas, LLC

Benefit/Effort Matrix – Completed Table 32 32 Organizational Ideas, LLC

Benefit/Effort 10 Matrix – 9 S Pursue 8 B T Plotted Matrix 7 R Q K C L 6 A Benefit 5 O Consider 4 H 3 G F Avoid, if Possible 2 I E N P 1 M D J 0 0 1 2 3 4 5 6 7 8 9 10 Effort 33 33 Organizational Ideas, LLC

Step 4 : PDSA Cycles 34 34