ADAP Clinical Quality Management Tutorial Two: How to Develop an ADAP Quality Management Plan

1. ADAP Clinical Quality Management Tutorial Two: How to Develop an ADAP Quality Management Plan

2. Learning Objectives: You Will Learn About… • Key terminology • Crucial elements of a quality management plan • Quality statement • Quality improvement infrastructure • Performance measurement and HAB ADAP performance measures • Annual quality goals • Engagement of stakeholders • Evaluation • Ten quality management rules for success • Putting your plan into practice

3. Quality Management Program Encompasses all quality activities, including the formal quality infrastructure (e.g., committee structures, roles for stakeholders, providers and consumers) and quality improvement related activities (performance measurement, quality improvement projects and quality training activities).

4. Quality Management Plan A quality management plan is a written document that outlines the quality program, including: A clear indication of responsibilities and accountability; Performance measurement strategies and goals; and, Elaboration of processes for ongoing evaluation and assessment of the program.

5. Elements of a Quality Management Plan • Quality statement • Quality infrastructure • Performance measurement • Annual quality goals • Engagement of stakeholders • Evaluation

6. Quality Statement: What Do We Want to Be? • Be brief and be visionary • Include internal and external expectations • Specify who are you serving ADAP Example …to provide access to appropriate HAART medications for the treatment of HIV/AIDS for all ADAP eligible clients in the state. General Example …to provide case management services to all Ryan White Part B eligible clients in the state.

7. Quality Management Plan Infrastructure • Leadership – who is responsible for each quality management initiative? • Accountability – when does the quality committee meet? Who do committee members report to? What are their responsibilities? • Quality committee(s) structure – who serves on the committee, chairs the committee? What is the length of term on the committee? • Resources – what resources are available to support the quality committee’s work?

8. Performance Measurement: How Will We Assess Progress? • Identify what’s important • Develop ways to measure • Include process, outcome, and satisfaction measures • Identify if your program has data to measure progress and how accurate, reliable and valid is the data • A good indicator consists of: • Relevance • Measurability • Accuracy • Improvability

9. HRSA/HAB ADAP Performance Measures The following are HAB’s Performance Measures for ADAP: • Percent of ADAP applications approved or denied for new ADAP enrollment within 14 days (two weeks) of ADAP receiving a complete application in the measurement year • Percentage of ADAP enrollees who are reviewed for continued ADAP eligibility two or more times in the measurement year • Percentage of new anti-retroviral classes that are included in the ADAP formulary within 90 days of the date of inclusion of new antiretroviral classes in the PHS Guidelines for the Use of Antiretroviral Agents in the HIV-1-infected Adults and Adolescents during the measurement year • Percent of identified inappropriate antiretroviral (ARV) regimen components prescriptions that are resolved by the ADAP program during the measurement year.

10. ADAP Example:Performance Measurement Performance Measure: Percent of ADAP applications approved or denied for new ADAP enrollment within 14 days (two weeks) of ADAP receiving a complete application. An ADAP working on improving this performance measure would use the current year as the baseline. For example - in 2010, 87% of applications were approved or denied within 14 days. In 2011 – 92% and in 2012 – 95%. Using the PDSA cycle, the ADAP would describe the program improvements they will make to spur the increase in percentage of applications processed within 14 days.

11. Annual Quality Goals: What Are the Priorities for the ADAP Quality Program? Quality goals are endpoints or conditions toward which a quality program will direct its efforts and resources. Three things to look at in designing goals: • Frequency: How many clients received and how many did not receive the standard of care/services? • Impact: What is the effect on clients’ health if they do not receive the appropriate care/service? • Feasibility: Can something be done about this problem with the resources available?

12. Tips for Engaging Stakeholders • Outline stakeholder functions/responsibilities • Include • Providers • ADAP clients • Other Ryan White Program Parts • List proposed training opportunities • Share your improvements with stakeholders and celebrate your successes

13. Evaluation: How Will We Assess the Quality Management Program’s Performance? • Infrastructure • Did we improve ADAP services? • Do we require further adjustment? • QI activities • Were goals achieved? • How effectively? Performance measures • Was the work plan executed as designed? • Were established milestones hit? • Were stakeholders informed? • Are results in the expected range?

14. The 10 Quality Management PlanRules for Success • Do not reinvent the wheel, use established frameworks to get started • Establish targets for goals and measure how you meet the targets • Length of the plan does not matter • 80% planning, 20% writing • A few visionary annual goals are better than plenty of useful ones

15. The 10 Quality Management PlanRules for Success • Be inclusive, even if it takes longer to get your final QM plan • If you have not touched your plan in the last 6 months, bring it to the next quality committee meeting • There is no such thing as a perfect plan • Plans are only as good as their implementation • Get started

16. Conclusion:Elements of a Quality Management Plan • Quality statement • Quality infrastructure • Performance measurement • Annual quality goals • Engagement of stakeholders • Evaluation

17. Test Question Which of the following is not one of the four HRSA/HAB ADAP Performance Measures? • Application determination • Eligibility recertification • Financial forecasting • Formulary • Inappropriate antiretroviral regimen components

18. Test Question The correct answer is: • Financial forecasting

19. Resources • Building Capacity of Statewide Quality Management Programs - NQC Guide for Ryan White HIV/AIDS Program Part B Granteeshttp://nationalqualitycenter.org/index.cfm/5918/17798 • For guidance in teaching small groups how to develop a quality improvement management plan, see the HIVQUAL Group Learning Guide "Quality Improvement Management Plan" exercise. You can download this publication athttp://www.nationalqualitycenter.org/index.cfm/5838/13400. • For examples and other general tips: The HIVQUAL Workbook, especially pp. 38-54. You can download this publication athttp://www.nationalqualitycenter.org/index.cfm/5659

20. For further information, contact: National Quality Center New York State Dept. of Health 90 Church Street, 13th floor New York, NY 10007-2919 Work: 212.417.4730 Fax: 212.417.4684 Email: Info@NationalQualityCenter.org Or visit us online at NationalQualityCenter.org For further information, contact: National Alliance of State and Territorial AIDS Directors 444 North Capitol Street, NW Suite 339 Washington D.C. 20001 Phone: 202.434.8090 Fax: 202.434.8092 Email: NASTAD@NASTAD.org Or visit us online at: www.NASTAD.org