Learning Objectives: You Will . . .

1. ADAP Clinical Quality Management Tutorial One:Introduction to Ryan White Program Quality Improvement for ADAPs 1

2. Learning Objectives: You Will . . . • Gain stronger understanding of Quality and Quality Improvement (QI) concepts and theories; • Review quality improvement as it relates to ADAP; and, • Identify available QI resources for ADAP grantees from HIV/AIDS Bureau (HAB).

3. Defining Quality

4. Key Question What do we mean by quality and how does this definition relate to the services ADAPs provide?

5. How the Institute of Medicine Defines Quality: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. ” Institute of Medicine. Medicare: A Strategy for Quality Assurance. Vol. 1. (1990)

6. Ryan White Program Emphasizes Quality Management: • The 2000 Reauthorization of the CARE Act directed programs under the CARE Act to develop and implement quality management programs. • All CARE Act programs were and still are required to establish quality management programs to: 1. Assess the extent to which HIV health services are consistent with the most recent Department of Health and Human Services (DHHS) guidelines for the treatment of HIV disease and related opportunistic infections; and 2. Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services.

7. What helps ADAPs achieve Quality? • Access to medications; • Evidence-based care; • Antiretroviral treatment; • Infrastructure to support adherence to treatment; and, • Adequate referral to HIV treatment for those not eligible for ADAP.

8. Defining Quality Improvement

9. What is Quality Improvement in HIV Care? • Continual improvement achieved through small, incremental changes; • A series of processes designed to result in improvement(s) in care; • Tailoring the HIV program to avoid processes that are not client centered; if not, clients may walk away from continuous HIV treatment; • QI processes work hand-in-hand with performance measures and quality indicators.

10. Implications for ADAP Quality Improvement • A performance measure provides an indication of a program’s or an organization's performance in relation to a specified process or outcome. • Use of performance measures that are quantifiable will increase the likelihood that a certain standard of quality will be achieved. • It is important to note that a systematic process identifies performance measures, vets them, includes staff input, tracks them for success and makes necessary changes along the way.

11. Implications for ADAP Quality Improvement • Ensure necessary therapeutics are made available and set up mechanisms to support treatment adherence; • Outreach to eligible participants; and, • Clearly define how the ADAP formulary is determined and how it changes over time as new pharmacological knowledge emerges.

12. Making Improvements in ADAP Programs • ADAP programs can achieve improvements by: • Having a written quality management plan • Conducting routine measurement of ADAP performance indicators and timely programmatic changes in response to the data • Conducting quality improvement activities such as the Plan-Do-Study-Act (PDSA) model and trainings • Having a functional quality management committee and giving the committee clear expectations and access to technical assistance

13. Key Points • Quality means meeting the needs of the people who access your services • Focus needs to be on processes • Poorly designed process = poor quality • Quality management committees are key to improving services at all levels

14. Test Question Which of the following statements concerning Ryan White Program requirements for Quality Management Programs are accurate? • Programs should adhere to established HIV clinical practices and DHHS guidelines to the extent possible • Quality improvement strategies developed should enhance access to appropriate quality HIV care • Demographic, clinical and utilization data that monitor trends in the local epidemic should guide improvement of programs • All the above

15. Test Question The correct answer is: • All of the above

16. Resources • For information on the history of the Ryan White Program: http://hab.hrsa.gov/livinghistory/timeline/legislation_hist.html • For information on the HIV/AIDS Bureau and its quality programs: http://hab.hrsa.gov/special/qualitycare.htm • For more detail on the programs operated under the Ryan White Program: http://hab.hrsa.gov/report_studies.htm • For the Institute of Medicine’s Report on quality management in Ryan White Program-funded grantees: http://www.iom.edu/CMS/3793/4819/16325.aspx • To find more resources on the Ryan White Program and also on quality improvement, please visit: http://www.NASTAD.orgor http://NationalQualityCenter.org

17. Resources • Building Capacity of Statewide Quality Management Programs - NQC Guide for Ryan White HIV/AIDS Program Part B Grantees http://nationalqualitycenter.org/index.cfm/5918/17798 • Institute of Medicine. Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act. Washington, DC: The National Academies Press, 2003. • Health Resources and Services Administration, HIV/AIDS Bureau. Quality Management: Technical Assistance Manual. Rockville, MD: HRSA/HAB, 2003. http://ask.hrsa.gov/detail_materials.cfm?ProdID=3027 • Berwick, Donald M, et. al., Curing Health Care. San Francisco, Jossey-Bass, 1990.

18. 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