Integrated Part A Outpatient Ambulatory Health Services and PrEP Learning Collaborative Session 2 Chicago Department of Public Health Public Health Institute of Metropolitan Chicago September 11, 2018
About PHIMC Public Health Institute of Metropolitan Chicago (PHIMC) enhances the capacity of public health and health care systems to promote health equity and expand access to services.
How PHIMC Works PHIMC leads efforts to strengthen the public health infrastructure in Illinois through: • Organizational Development • System Transformation • Fiscal Management • Program Implementation
The PHIMC 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 RW Part A QM Program resources and activities • Quality Management Infrastructure • Manage QM Resource Hub • Webinars • Facilitate revision of Standards of Care • Quality Improvement • Facilitate the Learning Collaboratives • Consumer Engagement • Support the Grievance Hotline • Evaluation • Support the annual Evaluation of the Grantee • Support the annual CAHISC Member Evaluation
Goals for LC2 • Review the learning collaborative and participant expectations • Explore quality improvement, sharing tricks and tools • Share tools for EMR and data extraction • Share success in attaining viral load suppression • Share success in attaining PrEP uptake
Agenda Agenda Item Presenters LC Refresher Audra Tobin: PHIMC Basics of Effective QI Barbara Schechtman Choosing a Good QI Project Daniel Pohl: Heartland Health Alliance Discussion of QI Tools Elizabeth Hamilton: Howard Brown Charlotte Detournay: AIDS Foundation of Chicago Break EMR and Data Extraction Bijou Hunt: Sinai Health Systems Success in Attaining Viral Load Katrina Barone: Erie Family Health Centers Suppression Success in Attaining PrEP Uptake Josh Brunsting: Open Door Clinics Group Activity Audra Tobin: PHIMC
Learning Collaborative Refresher
LC Refresher: Goal GOAL Utilize Quality Improvement (QI) methods to increase Pre- exposure Prophylactics (PrEP) uptake and viral load suppression rates among one of the four disproportionately affected populations: Youth 13-24 years. old, MSM of color, Transgender individuals, African American and Latina women.
LC Refresher: Purpose PURPOSE Assist PrEP and Outpatient Ambulatory Health Service (OAHS) providers in identifying effective methods to reduce the risk of new HIV infections and increase viral load suppression rates among disproportionately affected populations.
LC Refresher: Participant Expectations • Attend In-Person Meetings • November 15, 2018 and January 2019 • Conduct QI Activities and Document Progress • OAHS: Viral Load Suppression • PrIDE: Linked, Prescribed PrEP, Filled PrEP Prescription or Attended Follow-up Visit • Share your Expertise through Presenting during the LC • Signup for November and January LC due 10/14/2018.
Quality Improvement Basics of Effective QI Choosing Good QI Projects Discussion of QI Tools
Effective QI Barbara Schechtman
What is Quality Improvement? A. A way to figure out if you are meeting standards B. A process for looking at what is and figuring out how to make it better C. An internal agency culture D. A HRSA requirement /
What’s the very first step? A. Figure out what you mean by “quality” B. Try some changes and see what happens C. Report improvements over the last year
Data is important to the QI process because… A. It tells our funder what we are doing B. It proves we are doing good work C. We can figure out if change is needed and if change happens after we do something
Some key questions for doing QI work include… A. “How will we know if the change we make is an improvement?” B. “What can we do by next Tuesday?” C. “Why is our service not at the quality level we want?” D. “Why do I have to do this anyway?”
What resources can help us move ahead? A. PHIMC Quality Hub B. HRSA Target Center/CQII C. Our peers who have done this work before D. Robert Wood Johnson Foundation E. Institute for Healthcare Improvement F. Centers for Medicare and Medicaid Services
Questions? Barbara Schechtman barbaraschechtman@gmail.com
Quality Improvement Tools Charlotte Detournay: AIDS Foundation of Chicago
Utilizing visualization tools to track and enhance health outcomes Charlotte Detournay Senior, Ryan White Program Manager AIDS Foundation of Chicago 200 WEST JACKSON BLVD. | SUITE 2100 | CHICAGO IL 60606 | TEL 312-922-2322 | FAX 312-922-2916 | AIDSCHICAGO.ORG
Learning Objectives • To discuss limitations of databases and underscore the importance of utilizing visualization tools • To effectively use dashboards to pinpoint areas of concern related to subcontractor agency performance as well as denote trends to inform programmatic decisions • To demonstrate the use of a dashboard as a visualization tool to monitor and track health outcomes
Background of AFC • Founded in 1985 • Departments include: Housing, Care, Policy, Research and Evaluation, Finance and Communications • Braids multiple funding sources for Case Management into one Collaborative System • Lead agent for Case Management and Part B services for Region 7/8 • Fund over 30 agencies and 100 CMs within our EMA
Limitations of Databases • Reliance on manual data entry/reporting • Inability to showcase trends in data • Performance/Compliance • Viral suppression and other health indicators • Narrow scopes • Reporting and monitoring of data from multiple databases • Limited analysis of social determinants of health • Inability to evaluate correlation between case management and improved client health
AFC Programmatic Issues • Annual site visits • Feedback from last year’s data • CMs evaluated on 43 performance measures • Inability of finding software to combine data from multiple databases
QM Project • Revamped qualitative tool • Established dashboards • Data reviewed by Leadership Collaborative • Developed qualitative tool to monitor and track outcomes to barriers • Provided quarterly feedback to agencies
Dashboards • RW Performance Standards • Tracks monthly performance results for core CM standards • Viral Suppression • Filters viral suppression by demographic information and social determinants of health
Performance Dashboard
Viral Load Suppression Dashboard
Special thanks to: Alanna Berdanier (dashboard analyst) Joel Ritsema (dashboard developer)
EMR and Data Extraction
Using the EMR & REDCap to track patient navigation and medical care outcomes for HIV+ patients Bijou Hunt Sinai Infectious Disease Center Sinai Health System 9/11/2018
The Problem • We need a good system for tracking navigation and medical outcomes for both internal and external reporting and QI • Sinai uses Meditech as our Electronic Medical Record (EMR) – Meditech is not easily modifiable – Creating reports in Meditech is not a simple process – Previous approach of using Excel to track outcomes is not ideal • Only one person can be in the sheet • Sheet gets confusing! And too many sheets!! • Info is not easily shared across multiple users who may need access to patient info
The Solution
The Solution • REDCap database – Data can be imported into REDCap and updated easily – REDCap fields are chosen by the architect and can be easily added/modified – REDCap is incredibly user-friendly and staff have been able to make a seamless transition from tracking outcomes in Excel spreadsheets to using REDCap • Multiple staff can use at the same time • Multiple staff can view patient info relevant to them • Reporting capabilities are vast! • Eliminates need for multiple confusing sheets maintained by multiple different users!
So how do we get from the EMR to REDCap?
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