Ideas for Change in HIV Care

1. Ideas for Change in HIV Care The Quality Academy Tutorial 15

2. Learning Objectives: You Will Learn About… • What change concepts are • Examples of change concepts and improvements in HIV care • Where to find best practices Learning Objectives

3. Tips For Viewing This Presentation Read along with the narrator Search for keywords in the presentation Skip to other slides in the presentation Review current slide Play, rewind and fast forward View full screen Tips for Viewing

4. Key Question How can my HIV care program adapt and use solutions that have worked for others? Key Question

5. Exploring Change Concepts Change concepts applied to everyday activities: Hiking: take big steps Soccer: run to space Kayaking: paddle shallow Baking: handle the dough/batter as little as possible Piano playing: don’t look at the keys Change Concept Definition

6. More Change Concepts • Eliminate waste: eliminate multiple entry • Improve the work flow: minimize handoffs • Focus on time: reduce set-up or start-up time • Mistake proof: use differentiation Change Concept Definition

7. HIV Improvement Collaboratives • Sponsored by HRSA HIV/AIDS Bureau • Goals: • Working collaboratively • Learning from each other • Collaborative Demonstration Projects: • 2000: Part C and D • 2002: Part A • 2005: Part B • 2006: Low Incidence Initiative Part B Collaborative Change Concept Definition

8. Important Publications Examples

9. A) A specific idea of something different you should try B) A general idea of an area where you might make a change C) A notion or approach that helps you develop a change to test your own organization D) None of the above E) All of the above A change concept is: Test Question Test Question

10. Chronic Care Model Examples

11. Changes to Strengthen Community • Create a consumer advisory board • Create and maintain an updated list of community resources • Raise community awareness through networking, outreach and education • Establish linkages and connections to care within/across organizations • Identify and remedy current gaps in community resources Examples

12. Community: Case Example • Anchorage Neighborhood Health Center • Improve relationships with community resources • Quarterly case management meetings • Consumer advisory board • Group educational efforts Examples

13. Changes to Improve the Organization of Health Care • Assure senior and clinical leaders visibly support/promote improvement efforts • Assign accountability for continued clinical improvement at all levels of the organization • Make improving HIV/AIDS Disease care a part of the organization’s vision and mission • Integrate models into the “fabric” of the organization Examples

14. Organization of Health Care: Case Example • Albany Medical College AIDS Program • Focus on senior leadership • Structured meetings with all personnel, monthly or semi-monthly • Changed meeting format Examples

15. Changes to Facilitate Self-Management & Adherence • Train providers and other staff on how to help patients with self-management goals • Set and document self-management goals collaboratively with patients • Tap community resources to achieve self-management goals • Use planned visits in the individual and group setting to support self-management • Follow up and monitor self-management goals Examples

16. Self Management & Adherence: Case Example • Panhandle Community Services Health Center • Registry print-out as a self-management tool • Reviewed with patient each visit • Used by all providers • Patient then takes it home • Graphs found to be useful Examples

17. Changes to the Delivery System Design • Describe and document the new delivery system design • Assign roles, duties and responsibilities for all tasks • Educate patients about delivery system design • Include planned visits in the individual and group setting • Make designated staff responsible for follow-up Examples

18. Delivery System Design: Case Example • AIDS Care Group, Chester Pennsylvania • New organization, new design responsive to client needs • Clinical specialist • Counselors • Outreach systems Examples

19. Changes That Provide Decision Support • Provide feedback to providers on their use of care guidelines • Educate patients about guidelines • Establish linkages with key specialists • Incorporate community-based staff (social workers and case managers) into decision support • Provide continuous skill-oriented interactive training programs for all staff • Embed current guidelines in the care delivery system Examples

20. Decision Support: Case Example Christiana Health Care Services • Educational events for staff • Quick reference cards • Medical Director reports at staff meetings Examples

21. Changes to Strengthen Clinical Information Systems • Establish a registry • Develop an information infrastructure • Allocate resources for computer hardware and software, establishing and maintaining technical support, and personnel to support and maintain the registry • Use the registry to provide feedback to care team and leaders • Develop processes for use of the registry: data entry, data integrity, and registry maintenance • Use the registry to generate reminders and care-planning tools for individual patients Examples

22. Clinical Information System: Case Example Monroe County Health Department • Computer-based patient data system • Accessible to care team members at all sites • Consistent senior leadership support • Used to identify patients in need of screening Examples

23. Examples

24. A) HRSA HAB's website B) National Quality Center's website C) IHI's website D) None of the above E) All of the above The best source for information about changes that will improve HIV care is: Test question Test question

25. Key Points • A “change concept” is “a general notion or approach to change that has been shown to be useful in developing specific ideas for changes that lead to improvement” (Langley, et.al.) • Many change concepts have been developed for HIV care; the HRSA HAB improvement collaboratives are a good place to start • NQC is a forum for sharing information about best practices Key points

26. Resources • Langley, Gerald et. al., The Improvement Guide. San Francisco: Jossey-Bass, 1996 • Improving HIV Care: A Modular Quality Improvement Curriculum. Available on the National Quality Center website at: http://www.nationalqualitycenter.org/download_resource.cfm?fileID=16576 • HIVQUAL Workbook: A Guide for HIV Providers, New York State Department of Health AIDS Institute, 2006. Available on the National Quality Center website at:http://nationalqualitycenter.org/download_resource.cfm?fileID=16572 • For more information about the chronic care model, go to: www.improvingchroniccare.org Resources

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28. Related Tutorials • To learn more about HRSA’s improvement collaboratives and the Improvement Model, study Tutorial 12 • To learn more about PDSA Cycles, study Tutorial 13 Related Tutorials

29. The Quality Academy 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 In Closing