QUALITY 2017 MANAGEMENT P - Boston Public … Management Subrecipients ... A Medical Case Management clients from 85% to 88%. Goal 2: Establish a Boston EMA Part A Quality Management

QUALITY

MANAGEMENT

PLAN

BOSTON EMA

2017

Boston Eligible Metropolitan Area

Ryan White Treatment Modernization Act Part A & MAI

Boston Public Health Commission

Infectious Disease Bureau

Ryan White Services Division

1

TABLE OF CONTENTS

Contents

Background & Introduction .......................................................................................................................... 2

Timeline of Quality Management Activities ................................................................................................ 2

Definitions..................................................................................................................................................... 3

Mission .......................................................................................................................................................... 4

Vision ............................................................................................................................................................ 4

FY 2017 Goals & Objectives ........................................................................................................................ 4

Components of Quality Management ........................................................................................................... 5

Infrastructure ................................................................................................................................................. 5

Ryan White Service Division Roles and Responsibilities ........................................................................... 6

Stakeholders .................................................................................................................................................. 7

Ryan White Boston EMA Planning Council ............................................................................................... 7

Planning Council Committees .............................................................................................................. 7

Quality Management Committee .......................................................................................................... 8

Quality Management Subrecipients ...................................................................................................... 8

Performance Measurement ......................................................................................................................... 10

Health Outcome Measures (see also Appendix C) ............................................................................. 10

Quality of Life Outcome Measures ..................................................................................................... 10

Clinical Chart Review ......................................................................................................................... 10

Results and Dissemination .................................................................................................................. 11

Capacity Building ....................................................................................................................................... 12

Subrecipients ....................................................................................................................................... 12

Planning Council ................................................................................................................................. 12

Recipient ............................................................................................................................................. 12

Internal Program Evaluation ....................................................................................................................... 12

Resources .................................................................................................................................................... 14

2

Background & Introduction

The Boston Eligible Metropolitan Area (EMA) consists of seven counties in Massachusetts (MA) and

three in southern New Hampshire (NH). The recipient for Part A funds is the Boston Public Health

Commission’s (BPHC) Ryan White Services Division within the Infectious Disease Bureau (IDB). The

Quality Management (QM) program was originally established to guide the development of Standards of

Care for HIV services in MA and has now evolved into a comprehensive quality improvement component

for the Boston EMA.

In FY 2016, 74 programs were funded at 35 agencies. The 13 direct service categories are medical case

management, dental services, drug reimbursement, food services, housing, mental health, psychosocial

support (including mental health & substance abuse), residential substance abuse, medical nutrition

therapy, and transportation, as well as MAI services (medical case management and psychosocial support

services). The Boston EMA was awarded $14.2 million and served 5,040 clients in FY 2016.

Timeline of Quality Management Activities

1995 - 2009 Established universal HIV service guidelines

Established external system to collect client level outcome data

2013 Partnered with RDE Systems to create a new cloud based client level data system,

e2Boston

2015 Launched client level Outcomes Module in e2Boston

2017 Initiate and support quality improvement projects to improve viral suppression

Train agencies without quality improvement programs about the basics of quality

improvement

2018 50% Part A funded agencies have an HIV-specific quality management plan

50% of Part A agencies have completed two quality improvement activities

2019 100% of Part A funded agencies have an HIV-specific quality management plan

100% of Part A agencies have completed two quality improvement activities

3

Definitions

Quality Management (QM) Program encompasses all quality management activities and consists of the

Grantee’s Client Services and specific Quality Management staff, the involvement of fiscal and data staff,

quality management subrecipients, the Boston EMA HIV Health Services Planning Council, and the

EMA Quality Management Committee.

Quality Assurance (QA) refers to a broad spectrum of evaluation activities aimed at ensuring

compliance with minimum quality standards. The primary aim of quality assurance is to demonstrate that

a service or product fulfills or meets a set of requirements or criteria. QA is identified as focusing on

“outcomes,” and CQI identified as focusing on “processes” as well as “outcomes.”

Quality Improvement (QI) refers to activities aimed at improving performance and is an approach to the

continuous study and improvement of the processes of providing services to meet the needs of the

individual and others.

Continuous Quality Improvement (CQI) refers to an ongoing effort to increase an agency’s approach

to manage performance, motivate improvement, and capture lessons learned in areas that may or may not

be measured as part of accreditation. It is an ongoing effort to improve the efficiency, effectiveness,

quality, or performance of services, processes, capacities, and outcomes.

Plan, Do, Study, Act (PDSA) Cycle is a model of improvement used to test and implement changes in a

real work setting.

Plan: Identify Problems

Do: Use strategies/test that are designed to address the problem

Study: Collect and Analyze data to see if strategies have resulted in improvements

Act: If the strategies are effective, make them an ongoing activity; if not, return to the plan stage

Standards of Care (or Service Standards) are the minimal level of service or care that a Ryan White

HIV/AIDS Program (RWHAP) funded agency or provider may offer within a state, territory or

jurisdiction.

Recipient in this case the Boston Public Health Commission is the principal awardee of grant money

from HRSA. The recipient will implement work plans to ensure that the project’s goals and objectives are

achieved in an efficient and timely manner.

Subrecipient is an entity that receives a sub award from a recipient or another subrecipient under an

award of financial assistance and is accountable to the recipient or other subrecipient for the use of the

Federal funds provided by the sub award.

e2Boston is a cloud based electronic data system used to collect demographic and service utilization data

from subrecipients.

Demographic Data are client characteristics; such as, race, ethnicity, age and gender.

Service Utilization Data are units of services, types of service and service dates.

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Mission

The Quality Management Program (QMP) will work with all subrecipients to continuously improve the

quality of care and health outcomes among People Living with HIV (PLWH) in the Boston EMA,

particularly achievement and maintenance of HIV viral suppression.

Vision

The QMP will improve patient care, health outcomes, and patient satisfaction for PLWH throughout the

Boston EMA. To achieve this vision, the Ryan White Division staff will hold itself to the highest internal

standards to support a service delivery system that provides the high quality care. The commitment is to:

Share information, including current research and evaluation findings, with stakeholders.

Utilize all available internal and external data sources in an effort to best understand the service

population.

Consider and value the input of all stakeholders, especially consumers of HIV services.

Incorporate clinical guidelines and best practices into quality management activities.

Integrate quality management activities within Client Services and Planning Council activities.

Recognize the importance of a comprehensive continuum of care, including a combination of

core medical and support services.

Identify emerging needs and barriers to care in order to facilitate response.

Educate subrecipients, consumers, and the community about quality improvement.

Facilitate quality improvement activities.

FY 2017 Goals & Objectives

The Boston EMA Integrated Care Plan (ICP) lays out several goals for BPHC, MDPH and partner

organizations to achieve, based on known gaps and client needs within the EMA. The ICP goals informed

the first goal of the QM program, but two additional goals were chosen to establish processes that will

inform future QM activities. During FY17, BPHC QM will focus on increasing the proportion of virally

suppressed clients seen at agencies funded to provide medical case management, create an external

quality planning body, and formalize processes to ensure the QM plan is revised annually.

Goal 1: Promote health and wellbeing of all Boston EMA Part A clients and reduce the incidence of HIV.

In FY17, BPHC QM will work toward this goal by increasing viral suppression among Boston EMA Part

A Medical Case Management clients from 85% to 88%.

Goal 2: Establish a Boston EMA Part A Quality Management committee.

Goal 3: Maintain a Quality Management Plan for the purpose of guiding the formal evaluation and

assessment of the quality of services provided in the Boston EMA.

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Components of Quality Management

The infrastructure of BPHC, external stakeholders, the performance measurement system and capacity

building activities are integral to the success of the QM program. The infrastructure within BPHC will

play a key role in achieving QM goals because all Ryan White Services staff will play a part in QM

activities. All staff is expected to understand the basic principles of quality management and quality

improvement, and be able to communicate that knowledge to subrecipients or community partners. BPHC

will also work with Jon Snow Incorporated (JSI) and Boston University to gather data for QM activities

and lead quality improvement initiatives among subrecipients. Community stakeholders will advise

BPHC about QM activities through the QM Committee and other events that foster discussion about the

HIV service system, including Planning Council Meetings and community events.

The performance management system, or e2Boston, allows staff to track client level data in real time and

offers a window into agency and client performance at any time. e2Boston is critical for tracking progress

towards goals such as viral suppression and providing additional data to inform programmatic decisions.

The QM program has numerous resources to achieve the stated goals, including a strong medical case

management training program, the National Quality Center, and staff that are familiar with quality

management principles. Progress towards FY17 goals will be tracked through measurable objectives and

concrete action steps. This information will be routinely shared with Ryan White Services Division staff

as well as the QM committee. The goals are outlined with greater detail in the Appendix.

Infrastructure

The Part A Quality Management Program is housed within the Ryan White Services Division. The

division is one of four major departments within IDB, which includes the CDC Division and TB Clinic.

BPHC is the largest local health department in MA and is responsible for a broad range of public health

activities including disease surveillance and intervention services. The QM program supports internal

activities within the IDB and the Commission’s Office of Public Health Accreditation and Quality

Improvement to evaluate impact of services and community engagement efforts.

Dedicated QM staff lead all internal and external Quality Improvement activities. They report to a Ryan

White Services Division Director, who is responsible for overall administration of the Part A grant. The

Division Director reports to the ID Bureau Director, who also provides supervision and clinical expertise

to the QM program. Figure 1 is an organizational chart of the Infectious Disease Bureau:

6

Figure 1: Organizational Chart

Ryan White Service Division Roles and Responsibilities

Director, Ryan White Services Division: Supervises all activities related to Quality Management. The

work and implementation plan developed by the Sr. Program Coordinator of QM team requires the

approval of the Director of Ryan White Services Division. The director facilitates the integration of other

Ryan White Services Division staff into QM initiatives. Supervises QM staff and supports the process of

developing the work and implementation plan.

Quality Management Senior Program Coordinator: Responsible for the daily management of all QM

activities. QM Program Coordinators oversee the subcontracted work, monitor client health outcome

progress, and work to ensure that stakeholders, including subrecipients, have the resources that can aid

them in being successful.

Quality Management Program Coordinators: Analyze demographic and utilization data in order to

monitor trends in the local epidemic, identify issues which may need additional research, and report back

to stakeholders, including the Planning Council for service planning purposes.

Agency Monitoring Program Coordinators: Facilitate activities including, but not limited to, annual

subrecipient site visits, assisting subrecipients with the development of Plan of Corrective Actions, and

providing technical assistance to ensure agencies are adherent to the Standards of Care.

Contract Management Program Coordinators: Monitors subrecipients year-round for timely submission

of data and meeting service delivery quotas. This includes monitoring the progress towards service

utilizations goals outlined in the scope of services, processing budget revisions, and providing year round

technical assistance to ensure subrecipients are adherent to the Standards of care.

Infectious Disease

Anita Barry

Infectious Disease

Administration Ryan White Services Division Dennis Brophy

Agency Monitoring

Contract Management

Quality Management

Education and Community Engagement

Planning Council

Executive NRAC SPEC

CDC Division TB Clinic

7

Infectious Disease Bureau Administration: Processes subrecipients’ invoices, manages budgets, and

performs annual fiscal site visits.

CDC Division: CDC Data Manager works with QM staff to oversee development and maintenance of

e2Boston and conducts all site administrator duties.

Stakeholders

Ryan White Boston EMA Planning Council

The Planning Council is a key player in quality management activities. All evaluation products are

presented to the Planning Council, and the information is used to inform the Priority Setting and Resource

Allocation processes. QM Coordinators will attend Planning Council meetings quarterly. QM

Coordinators will create and make presentations to the Planning Council and respective committees

regarding client health outcomes data, demographic data, and service utilization data each year.

Figure 2: Planning Council Cycle

Planning Council Committees

Needs, Resource & Allocation Committee (NRAC) is responsible for executing the development and

implementation of a process to identify current needs of individuals with HIV and their caregivers, and

assesses the impact of Part A funding and programs within the EMA. QM staff provides oversight on

Needs Assessment projects.

Services, Priority & Evaluation Committee (SPEC) Evaluation activities are first presented to SPEC for

feedback before presentation to the full planning council. SPEC is integral to evaluating BPHC’s

performance as the lead administrative agent for the grant.

8

Quality Management Committee

This formal committee will work with the Quality Management team to monitor the progress of QM

objectives. Members of the QM Committee provide feedback while reports are in draft stage, review

research protocols/tools, and help shape the overall Quality Management Program. Each year, the QM

Committee includes suggestions for future evaluation projects in their annual year-end report.

Quality Management Subrecipients

John Snow Inc. (JSI) The subrecipient utilizes staff with expertise in medical record abstraction, data

analysis, and qualitative research to conduct the Clinical Chart Review project and other activities for the

grantee. JSI has the expertise, technical skills, and capacity needed to administer quality management

studies in the Boston EMA. JSI helps design the studies, analyze the data, and communicate the results to

BPHC and the Planning Council.

Communication: The Quality Management Coordinators manage the Evaluation contracts and

communicate with JSI frequently regarding project progress. QM staff is the primary point of contact for

JSI, and QM staff is responsible for including the Ryan White Division Director and Infectious Disease

Bureau Director in key project decisions. Planning meetings are held throughout the year, as needed. JSI

is also required to submit quarterly progress reports to the Grantee.

Boston University (BU): The Boston University School of Public Health – Center for Advancing Health

Policy and Practice (CAHPP) is funded to analyze disparities in achieving health outcomes among PLWH

in the Boston EMA. CAHPP’s organizational mission is to advance the well-being and health of

vulnerable populations.

The Performance Gap Analysis includes examination of the provision of core services and support

services among affected populations. This project is intended to serve as a tool to guide the Council’s

work in the upcoming years in making decisions about the HIV service gaps in the Boston EMA. This

analysis looks to identify barriers that prevent PLWH both in and out of care from receiving needed

services or from continuing in care, including an assessment of unmet needs for PLWH who know their

HIV status but are not in care and strategies to reach out to those unaware of their status. Data will be

gathered through several focus groups among HIV care providers and PLWH, as well as consumer and

provider surveys distributed throughout the Boston EMA. CAHPP will also provide recommendations to

address disparities and information to promote quality improvement activities and innovations.

The study will focus on special populations identified in previous Planning Council and BPHC work.

These populations have been selected based on a combination of variables below:

Age

Gender

Race and ethnicity

Year of diagnosis

Commonly occurring comorbidities

Viral suppression rates

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Communication: Planning Council Support staff regularly holds conference calls with BU staff to discuss

project updates. BU is scheduled to present preliminary study results to the Planning Council in March

2017 and publish a final report in April, 2017.

Subrecipients: Providers are engaged in quality management through the annual Provider Training,

where they meet the Quality Management team and learn about new features in e2Boston or new

reporting requirements. The JSI program requires the cooperation of providers while performing

evaluation studies; the training is a way to introduce providers to the annual quality management

initiatives and explain how they can help make the projects successful. All service providers also have

the option to request quality management technical assistance throughout the year.

Communication The Quality Management team communicates directly with Providers at the end of the

2nd

and 4th quarters for submission of client outcome data. Every other year during an agency’s site visit,

a Quality Management Coordinator reviews the Standards of Care with staff to ensure their Part A and/or

MAI programs are providing the quality of service expected by BPHC. Providers can also request

technical assistance for outcome submission or compliance with the Standards of Care at any point

throughout the fiscal year.

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Performance Measurement

Quality Management performance measurement activities include reviewing and analyzing client health

and outcome information, stratifying outcome measurement information by demographic characteristics,

and using clinical chart review data for quality improvement.

BPHC collects health and quality of life outcomes through e2Boston. Providers are required to submit

outcome reports for each client they serve according to the Client Clock Model. The Client Clock Model

is based on outcome due dates of service utilization patterns for each client. When a client access

services, he is then considered eligible for a report and the report is due six months from the date of

service. One outcome report will cover all services received within the six month period. After that period

expires, the client is considered ineligible for submission until the client receives another service.

Health Outcome Measures (see also Appendix C)

1. CD-4 counts – client has a CD-4 count greater than 500

2. Viral load – client has HIV viral load less than 75 or an undetectable level

3. Date of most recent HIV medical appointment – month and year in which client was last

seen by their HIV medical provider (to monitor whether clients are receiving care every

six months)

4. Adherence to prescribed HIV medication – client always adheres to HIV medications as

prescribed

5. Active engaged with medical case management program – to monitor whether or not a

client is receiving medical case management services, and where.

Quality of Life Outcome Measures

6. Impact of side effects from HIV medications – client has no side effects or side effects

are not impacting activities of daily living

7. Severity of side effects of HIV medications – client has no side effects

8. Mental health status – client shows no indication of mental health problems

9. Access to support network – has very strong personal support network(s) that can be

consistently relied upon

10. Care Adherence – client is often or almost always able to attend HIV-related

appointments

11. Housing status – client has stable and satisfactory housing

Clinical Chart Review

JSI is responsible for evaluating quality of care through clinical chart reviews every two years at medical

sites providing medical case management in the Boston EMA. This information forms a foundation for

agencies to initiate quality improvement projects. Clinical chart review reports and special evaluation

reports using these data are produced every other year, creating a constant stream of incoming knowledge

for Quality Management staff. JSI is also responsible for the dissemination of feedback to the clinical

sites and site-specific data is made available to the Grantee. To focus attention of the clinical staff on the

11

quality management findings, JSI staff prepares summary presentations for each clinic and delivers them

via webcast, conference call or in person for staff use and discussion. The information focuses on key

process and clinical indicators, comparing earlier rounds of data collection with the most recent round, to

examine trends and identify areas in need of improvement. Discussions explore underlying problems or

successes from the individual providers’ perspectives and generate new questions and requests for

focused technical assistance.

The Quality Management team arranges meetings and conference calls with JSI to discuss projects, as

needed. Regular communication about ongoing evaluation projects helps to prevent issues and allows the

Quality Management Program Coordinators to help shape the reports/studies.

The clinical performance indicators evaluated are the current HAB measures: medical visits; CD4 count;

PCP prophylaxis; antiretroviral therapy; Hepatitis A and B vaccinations; Hepatitis C treatment when

applicable; pneumococcal vaccination; and Pap smears among female clients.

Results and Dissemination

Results from reports and research are disseminated by various means including the Boston Public Health

Commission website, provider forums, email communication to providers, and multiple presentations at

the Planning Council and committee meetings. The information collected through JSI and BU work is

important for funded agencies in the services they provide and also for the Planning Council in their

decision-making processes. The Quality Management Program reviews all reports and uses the

information to monitor trends or changes in populations, identify gaps of knowledge, and share with

providers to inform best practices at their agencies.

The quality management program will release quarterly reports summarizing performance measures

system wide for all subrecipients to review. Additional reports are released annually which summarize

client demographic and client service utilization.

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Capacity Building

Subrecipients

Quality Management Technical Assistance and Training: The QM Program Coordinator will be

responsible for consulting with agencies and will assist in the development of QI initiatives. A Technical

Assistance form will be introduced during FY 2017. This form will allow funded agencies to request

Technical Assistances and Training sessions focused on QI Activities.

Throughout the year, Providers can request technical assistance for any issues related to quality

improvement, outcome collection and submission. If there is a request for technical assistance, a Quality

Management Coordinator will visit the agency and conduct in-person training or invite staff to 1010 Mass

Ave. for training. Also, Providers are encouraged to contact the Quality Management Program if they

have new staff members learning the outcome system.

Planning Council

PCS Evaluation Training: PCS staff will offer several optional trainings to members of the Planning

Council. One of the annual trainings will be “Understanding Evaluation Materials,” facilitated by the QM

Coordinators. This covers the structure of the QM Program and introduces any different types of

evaluation study designs, how evaluation studies are used to inform service delivery, and various

interactive exercises using actual evaluation reports.

Recipient

National Quality Center Technical Assistance Webcasts: The Quality Management Program

Coordinators occasionally participate in the monthly NQC webcasts. The presentations provide a unique

opportunity for Quality Management Programs across the country to share information. Ryan White

Services staff is invited to join the webcasts and often provide a different perspective on the topic

presented. This builds quality management capacity among the team and serves as a refresher for staff

members who are not directly working in quality improvement.

Internal Training: QM Staff are responsible for training BPHC staff on best practices in quality

management and cover the basic knowledge of quality management and improvement.

Internal Program Evaluation

Quality Management Goals and Objectives: QM staff will use the goals and objectives table (Appendix

A) to track deadlines and project progress throughout the year.

Quality Management Team Meetings: QM staff will host regular check-in meetings to discuss the status

of projects, upcoming deadlines, and any pressing issues. This helps set manageable goals and keeps the

program running efficiently. The Program Coordinators also schedule monthly meetings with senior

Ryan White Division staff to keep them informed about quality management activities.

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Updating Quality Management Plan: The Quality Management Program Coordinators will be

responsible for initiating the review and updating the Quality Management Plan at the end of each fiscal

year. Annual quality goals will be developed using the previous years’ evaluation study results, site visit

findings, service utilization data, and the annual client outcomes report. The Quality Management team

will create a draft plan that will be reviewed by the, the Director of the Ryan White Services Division and

senior staff, a Client Services Program Coordinator, and the Planning Council. Quality Management

Coordinators will incorporate feedback from the review team and a final plan will be signed off by the

Coordinators, management, and the Chair of the Evaluation Committee.

Outcome Measurement System Review: Each year QM staff will review Performance Measurement

indicators and assess their appropriateness for evaluating client health outcomes and the HIV service

delivery system. Performance measures which are no longer relevant need to be discarded or redefined.

Yearend report/Plan Do Study Act (PDSA): At the end of each fiscal year, QM staff will evaluate

program performance by comparing annual program goals to the work completed. Progress, or lack

thereof, will assist QM staff with creating goals for the following year.

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Resources

National Quality Center (NQC) The National Quality Center’s website, webcasts, and staff are often

utilized by Quality Management Program Coordinators and shared with Program Coordinators and

service providers.

HRSA/HAB offers technical assistance (TA) calls and webcasts on a number of topics relevant to data

and quality of care.

Local Collaborative Groups Service providers will participate in local groups, such as NQC sponsored

regional quality management group.

Boston EMA Planning Council The Planning Council consists of an array of service providers, policy

makers, and consumers; this diversity of perspectives makes it an indispensable source of knowledge.

Frequent educational presentations by stakeholders in the Boston EMA HIV service delivery system also

make the Planning Council a valuable resource.

State Health Departments Collaborations with the Massachusetts Department of Public Health’s Office

of HIV/AIDS (MDPH) and New Hampshire’s STD/HIV Section within the Department of Health and

Human Services allow for access to pertinent data resources and research.

Data A wealth of data is available to the Quality Management Program, including internal client-level

utilization and demographic data. Collaborations with state counterparts in Massachusetts and New

Hampshire also allow for sharing of surveillance information.

Public Health Community the Quality Management Program engages the community through

networking at external trainings, supporting advocacy initiatives, and posting evaluation reports on the

Boston Public Health Commission’s public website.

Consumers It is absolutely essential to engage consumers in quality management. Consumers regularly

participate in annual evaluation studies. Providers help spread the word about Grantee-sponsored studies

to ensure consumer participation. Consumers participate in the Evaluation Committee, interviews, focus

groups, and satisfaction surveys. Additionally, the Quality Management team presents evaluation project

results at the Consumer Committee, another formal Planning Council committee.

Regional Quality Management Group The Regional Quality Management group brings HIV service

providers from Massachusetts together to share best practices in quality management and collaborate on

larger quality improvement activities. The group meets quarterly and is overseen by the National Quality

Center (NQC) (see nationalqualitycenter.org).

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Appendix A: FY 2017 Annual Quality Goal

Goal 1: Increase viral suppression among Boston EMA Part A Medical Case Management clients

from 85% to 88%.

OBJECTIVES RESPONSIBLE

PARTY ACTION STEPS

Objective 1: Identify three

agencies with the lowest viral

suppression rates

BPHC QM staff Use e2Boston to identify racial/ethnic disparities in viral suppression at each agency.

Review prior Outcome Summary reports to identify previous disparities in viral

suppression

Objective 2: At each of the

three agencies, identify

common barrier to viral

suppression among

unsuppressed clients in the

affected demographic group

BPHC QM staff Guide agency to review unsuppressed client population to identify barriers that impact the

largest proportion of clients

Objective 3: Work with each

agency to develop targeted

quality improvement activity

around identified common

barrier

BPHC QM staff Review agency’s resources for quality improvement

Identify key staff to carry out QI activity

Provide training on PDSA

Assist agency with creating PDSA plan

Objective 4: Assist target

agencies with PDSA cycle

BPHC QM staff Monitor PDSA process, regularly check in with agency staff

At end of cycle, summarize findings and results

Objective 5: Review

additional MCM programs for

demographic disparities for

viral suppression

BPHC QM staff Share experiences from first three agencies with other funded MCM providers.

Goal 2: Establish a Boston EMA Part A Quality Management committee. Objective 1: Work with

Planning Council and other

stakeholders to create a CQM

committee

QM Staff, PCS

Staff, HIV Division

Director

Identify volunteers to form 3-6 person committee

Educate committee members about CQM and QI

Review QM plan and devise additional action steps to facilitate QI activities in the Boston

EMA

Objective 2: Identify agenda

for Committee

Committee

members, QM

staff, PCS

Review QM Plan and goals

Identify topics to explore through discussion in Committee

Objective 3: Set dates and

times for meetings one year out

Committee

members, QM

staff, PCS

Committee will meet regularly at least once per quarter

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Goal 3: Maintain a Quality Management Plan for the purpose of guiding the formal evaluation and

assessment of the quality of services provided in the Boston EMA.

GOAL RESPONSIBLE

PARTY ACTION STEPS

Objective 1: Review and

update quality management

plan.

QM Coordinators,

SPEC, Director of

Ryan White

Services Division

and other Senior

BPHC staff

Update any cited numbers and dates

Revise outdated language about work processes

Conduct literature review to determine validity of performance indicators

Objective 2: Establish

guidelines for quality

management plans and

activities for funded agencies.

QM Coordinators Identify minimum requirements for sub-recipient QM work

Embed QM expectations into contracts reflecting legislative requirement

Discuss QM plans with providers and educate providers on how to write QM plans where

necessary.

Objective 3: Identify clinical

indicators which need

improvement using chart

reviews.

JSI, QM

Coordinators Compare updated chart review findings with previous findings.

Communicate with JSI re: differences.

Based on findings, create action steps.

QM coordinators participate in TA calls with Primary Medical Care providers.

Objective 4: Review outcome

measurement data related to

HAB measures bi-annually.

QM Coordinators Provide TA to providers regarding the new outcome measures, the new Access database

and the electronic uploading of files prior to the March submission deadline.

Present at Provider Training in April.

Clean data upon receiving.

Share data with JSI for analysis.

In conjunction with JSI, determine analyses for Annual Report (Part A & MAI separately).

Evaluate data completeness of newly included outcome measures.

Readdress outcome instructions based on successes and challenges of new reporting

requirements.

Objective 5: Determine the

effectiveness of the QM

Program infrastructure and

activities

QM Coordinators,

QM Committee Work with QM Committee to review annual goals and objectives

Identify which deadlines were met and which were not

If work is past deadline, create workplan to ensure timely completion

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Appendix B: FY17 Quality Management Goal Logic Model

Goals

•Promote the health and wellbeing of PLWH

• Reduce incidence of HIV within the Boston EMA

Outcomes

•Increase Vrial Suprression rates from 85% to 88% within the Medical Case Management service category

Resources

•E2Boston

•Subrecipients

•Client Services

Activities

•Identify high acuity, virally unsupressed clients

•Develop plan to engage unsuppressed clients

•Conduct workgroups to share best practices

Outputs

•# of High Acuity Virally Suprressed clients identifeid

•# of "Reaching Suppression" plans

•# of workgroups held

Goals

•Establish a Boston EMA part A Quality Management Committee (QMC)

Outcomes

•Increase community participation in the planning and execution of quality management activities

Resources

•Planning Council Members

•Planning Council Support

•Subrecipients

•Client Services

Activities

•Develop clear role and responsibilities for a committee

•Recruit Planning Council Members to new committee

Outputs

•# of meetings of the new committee

•# of new members recruited

•Mission Statement for the new committee

Goals

•A quality management plan that is updated annually in collaboration with Quality Management Committee and guides quality management activites conducted by the Quality Managment program

Outcomes

• Improve the quality management process for the Boston EMA

Resources

• E2Boston

•QMC

•Health, Resources and Services Administration (HRSA)

• Subrecipients

•Client Services

•National EMA/TGA Network

• JSI

•Boston University

Activities

•Develop quality management activity timeline

•Develop clear guideslines of quality management activities expected by subrecipients

Outputs

• Timeline

•Guidelines for Subrecipients

• # of meetings with Quality Management Committee

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Appendix C: FY 17 Performance Measures Targets

Service

Category

Performance

Measure

(N) Description (D) Description % Source

Medical Case

Management

Viral Suppression 2,027 Number of patients in the denominator with a

HIV viral load less than 75 copies/mL at last

HIV viral load test during the measurement

year

2,330 Number of patients with at least one HIV

viral load test during the measurement year

82 e2boston

Medical Case

Management

(MAI)

Viral Suppression 205 Number of patients in the denominator with a



year

260 Number of patients with at least one HIV


79 e2boston

Housing Housing Status 15 Percentage of patients in the measurement

year there were homeless

510 Percentage of patients who received Ryan

White Part A funded housing services

during the measurement year

3 e2boston

AIDS Drug

Assistance Program

HIV Medical Visit

Frequency

65 Percentage of clients who reported an HIV

medical visit within the previous six months

85 Percentage of clients who received an

ADAP service during the measurement

year

76 e2boston

Oral Health Care HIV Medical Visit

Frequency

1,245 Percentage of clients who reported an HIV


1,500 Percentage of clients who received an oral

health care service during the measurement

year

83 e2boston

Psychosocial

Support (Peer

Support)




year



89 e2boston

Psychosocial

Support (Peer

Support, MAI)




year



77 e2boston

Psychosocial

Support (Mental

Health)

HIV Medical Visit

Frequency



136 Percentage of clients who received an

psychosocial support – mental health

service during the measurement year

76 e2boston

Psychosocial

Support (Substance

Abuse)




year



80 e2boston

Residential

Substance Abuse




year



65 e2boston

19

Food Bank/Home

Delivered Meals




year

1,215 Number of patients with at least one HIV


71 e2boston

Medical

Transportation

HIV Medical Visit

Frequency



1,028 Percentage of clients who received a

medical transportation service during the

measurement year

85 e2boston

Medical Nutrition

Therapy




year



87 e2boston

Documents

QUALITY 2017 MANAGEMENT P - Boston Public … Management Subrecipients ... A Medical Case Management clients from 85% to 88%. Goal 2: Establish a Boston EMA Part A Quality Management