CDPH Ryan White Part A Early Intervention Services (EIS) Learning Collaborative Series Meeting #2 Tuesday, September 20, 2016
Agenda • Welcome • Learning Collaborative Structure & Requirements Recap • EIS Service Category Refresher • Quality Improvement Check-In: Where Your Agency Should Be • Agency EIS Program Presentations o Austin CBC o Mount Sinai • Root Cause Analysis as a QM/QI Tool • Coaching Team Meeting & Discussion • Close
Goals for Today’s Meeting 1) Gain a solid understanding of CDPH Learning Collaborative structure and purpose. 2) Obtain new ideas about EIS program best practices. 3) Understand root-cause analysis as a QM/QI tool. 4) Identify concrete next steps in the QIP process.
PHIMC Mission and Vision Public Health Institute of Metropolitan Chicago (PHIMC) enhances the capacity of public health and health care systems in Illinois to promote health equity and expand access to services.
How We Work PHIMC leads efforts to strengthen the public health infrastructure in Illinois through: • Organizational Development • System Transformation • Fiscal Management • Program Implementation
How does PHIMC fit into Ryan White Part A? • Technical assistance provider partnering with CDPH to implement Ryan White Quality Management (RW QM) across the Chicago EMA. • Prior to March 2015, MATEC was lead on this project for 14 years. • MATEC contracted primarily with Training Resources Network- Ms. Susan Thorner’s consulting agency.
The CDPH RWQM Program is…. A partnership between PHIMC and the Chicago Department of Public Health’s Quality Management (QM) Unit to provide training, technical assistance, and capacity building support to Ryan White Part A funded agencies in an effort to maintain sustainable internal QM infrastructure across the Chicago EMA.
PHIMC and CDPH collaborate on the following items: • QM Site Visit Implementation • Audit Tool Creation & Data Collection • Learning Collaboratives • Webinars How is RWQM Implemented? • Sub-recipient and CAHISC member surveys • Conflict Resolution Training & Grievance Access • Support core MATEC Trainings • Updating CDPH Standards of Care • Generating QM Newsletter/Online QM Resources • Participation in Community Planning Efforts, i.e. CAHISC and the MAG
What is Quality Management (QM) vs. Quality Assurance (QA) or Quality Improvement (QI)? • Quality Assurance : Checking Boxes i.e. Program Monitoring Site Visits • Quality Improvement : Enhancing Services i.e. Increasing percentage of AOMC clients receiving STI screening • Quality Management : All functions to evaluate and improve quality i.e. QM committee + QM plan + QM site visits from funder, etc.
What is a “Learning Collaborative”? • Model developed by the Institute for Healthcare Improvement (IHI) in 1994, later adopted by NQC & HRSA • Since 2000, NY State Health Department has tested LC model with RW Parts A-D • In 2008, NQC published LC guide for RW providers nationwide • Implementing quality improvement & identifying best practices • Designed for clinical care http://nationalqualitycenter.org/files/planning-and-implementing-a-successful-learning-collaborative-pdf/
What is a CDPH Ryan White Part A Learning Collaborative (LC)? • One Ryan White core service category selected based on CDPH Quality Management site visits from previous year. • At least four LCs occur in given grant period (March 1 st - Feb 28 th ). • Agencies that received QM site visit in previous year are required to attend. • Open to all CDPH RW Part A funded agencies.
Who should attend an CDPH RW Part A LC? • CDPH Ryan White Part A-funded agencies • Designated members of RW quality improvement team OR agency staff implementing the service category in question • For 2016 EIS focused series, this may include: - Member of RW QI team - Program Managers - EIS specialists - LTC staff - Anyone else instrumental in implementing EIS
What are the requirements for LC participants? • Register and attend four Learning Collaboratives. • Complete and present on one quality improvement project for your agency by January 25, 2017. • Work with and report to assigned coach as necessary. Ultimately to improve quality of designated RW program(s) at your agency!
2016 Early Intervention Services (EIS) Learning Collaborative Series: Structure • Four provider meetings • Best Practices Presentations from EIS Providers • Quality Improvement Tips, Tricks, Trends • Built in time to meet with coaches & team
Acknowledging the challenges with utilizing EIS in an LC format • Brand new service category • Limited data • Standards of care do not include measurable indicators • Intervention contains non-clinical/social components
What We Know: The 4 Buckets of Early Intervention Services (EIS) • HIV Counseling and Testing • Linkage to Care • Referrals • Health Literacy
Applying the NHAS Indicators to EIS NHAS Indicator 4: Increase percentage of newly diagnosed person linked to HIV medical care within one month of their diagnosis to at least 85%. NHAS Indicator 5: Increase the percentage of person with diagnosed HIV infection who are retained in HIV medical care to at least 90%. NHAS Indicator 6: Increase the percentage of persons with diagnosed HIV infection who are virally suppressed to at least 80%.
Steps to selecting an EIS Quality Improvement Project Step 1 : Select an NHAS indicator. Step 2 : Select one of the buckets of EIS. Step 3 : Identify small-scale projects. Step 4: Conduct PDSA.
Quality Improvement Projects: Where You Should Be Step 1 : Select an NHAS indicator. Step 2 : Select one of the buckets of EIS. Step 3 : Identify small-scale projects. Step 4: Conduct Plan, Do, Study, Act cycle(s), also known as PDSAs
Quality Improvement Projects: Where You Should Be Step 4: Conduct PDSA(s) PDSAs are a small part of a larger quality improvement project. How do they fit into the larger project?
QIP vs. PDSA Example QIP : Increase % of clients linked to care. Example PDSA : One peer navigator makes home visits for short period of time. Data is essential to illustrate where you are, where you want to go, and where you end up.
More questions about the Process? Ask your coach and your team!
EIS Program Presentations Austin CBC • Cook County Health & Hospital Systems • Community-Based Org Mount Sinai Hospital • Hospital System
Austin CBC Initiative Early Intervention Services (EIS) PROJECT SNAPSHOT September 2016 EIS Team: EIS Coordinator: Chamille Johnson, CHES EIS Specialist: Lasheena Miller (2) Medical Case Manager (s): Cerese Depardieu, Lajanice Page (2) Peer Navigator (s)
PROJECT FUNDED SCOPES HIV Testing and Counseling Referral Services Linkage to care and/or Re-engagement to care Health Education and Literacy Training
SCOPES PROGRESS TO DATE Activity Goal Unduplicated Units of Clients Service Counseling/Testing 400 265 269 Health Education/ Literacy 28 25 171 Referral Linkage to Care- 12 14 14 Primary Referral to Specialty Care 28 15 39
HIV Testing and Counseling Project Goals coincide with NHAS goals to increase the amount of individuals tested and aware of their HIV status. HIV Testing and counseling conducted at CCHHS Austin Clinic onsite daily Weekly at Austin Community Area Food pantry. Testing conducted monthly at outreach activities and special community events Mobile testing w/partner Community Based Organization Association House HIV testing and counseling sessions Client is provided with personalized risk assessment SMART GOALS are discussed and client centered behavioral change set. Client is provided with demonstration as needed Condoms Clients who qualify for PrEP are referred onsite.
Linkage to care and/or Re-engagement to care EIS specialist enrolls Ryan White eligible clients who are newly diagnosed or have been out of HIV care for 6+ months: Clients are referred for linkage through Outreach, Offsite/onsite HIV testing, Referrals from local CBO’s, CCHHS, and CDPH STI clinics. 1. EIS Linkage Coordinator will follow up with client regarding Confirmatory test result by scheduling appointment once results become available via Cerner. 2. EIS Linkage Coordinator or EIS Specialist will schedule follow up appointment in Cerner with an assigned clinician. 3. EIS Linkage Coordinator or EIS Specialist will refer client to Ryan White Medical Case Management onsite for case management services, Program intake, and referrals to other supportive services. 4. Client sees EIS Specialist, Peer Navigator or Linkage coordinator for counseling, and Health Education/Literacy Training. Client sees LCSW for Mental Health Screening. 5. Client receives EIS services until deemed ready for case closure by EIS staff.
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