Quality Management Planning Missouri Department of Health and Senior Services Bureau of HIV, STDS and Hepatitis December 2005 Prepared by: Barbara Boshard Barbara.Boshard@dhss.mo.gov Rita McElhany Rita.McElhany@dhss.mo.gov Really glad to have the opportunity to brag about Missouri!

How we got started? All Grantees response to the “Outcomes Evaluation Technical Assistance Guide” Ranked data outcome priorities and capabilities during All-Grantees Retreat in May 2002 Ranked data outcome priorities and capabilities through MACMIP Talk about the history of the grantees titles 1, 2,3, 4 and MATEC The agreements: We are stronger when we work together That health care and meds are the highest priority The system is needs-based That we will do the best we can with the resources we have MACMIP is the Quality Improvement group the case management system that is representative of titles, consumers, case managers, providers and other state agencies by our 6 regions (25-50 people)

Survey Rankings of Data Priorities 3 – Our title must have now or near future 2 – Our title will need for future grant applications (Next 2-5 years) 1 – Oh yow HRSA! In a perfect world this would be helpful but right now it’s just a dream. 0 – You just can’t pay me enough to collect this!

Results of Survey NOW – CD4 and VL by Calendar Year to reflect Primary Care access NEXT – Retention in Primary Care, Med Adherence, Referral for Mental Health and Substance Abuse FUTURE – Tracking Points of Entry, Service Referrals, Effective Care Plans How are we getting this stuff? CD4 VL…MO has many data benefits….all inclusive, centralized database systems that talk with one another; surveillance group provides link between HARS, FACTORS, MIS?

Developing Missouri’s view of QM Responding to GPRA and PART Goals Tracking and reporting Missouri’s GPRA and PART outcomes by year for Stakeholders MO valued linkage with Kansas City and St. Louis’ QM efforts GPRA Government Performance Review Act PART Program Assessment Rating Tool KC was part of first title I QM Collaborative Stl has requested TA from NQC for 2005

MO-Hat-ters Forms! Applied and accepted to be part of HAB Title II QI Demonstration Project Formed 12 member team representing multiple RW titles, providers, surveillance, key Ryan White Title II staff, and a consumer MO-Hat-ters to become QM subgroup of All Grantees meetings Why are we called MO-Hat-ters? 6 Hat thinking Edward DeBono using colored hats to represent and define effective roles in successful groups Will continue to be the QM subgroup after the collaborative ends

Components of the Missouri QM Plan Vision Purpose Goal Definitions Structure Improvement Plan Grid Outcomes Capacity Building Communicating and Acknowledging QM Results Signature/Date/Review Date Page This is ongoing hence living, breathing! Structure refers to the partnership among titles Some paid positions to support QM at the state through the other titles, HSI, and for data Defined meeting schedules Improvement Plan Grid is ongoing to be revisited both by the QM group and the grantees throughout the year

Improvement Plan Grid Components Measures Evaluation Tools Target Frequency of Reports Responsible Person Program Outcomes PDSA Improvement Strategies Re-evaluation Living and breathing Kind of parallels the care plan! We try to identify the measures thru a variety of sources…GPRA/PART, Scope of Work outcomes, Title II collaborative measures, Specific Title outcomes.. Improvement plan grid has both process and outcome measures

Implementing the QM Plan Drafted and Presented QM Plan for Grantees and MACMIP in September Commitment from 9 Grantees and 1 ASO for QM Plan Signature page developed for All Grantee Directors to sign to signify adoption Final Version Presented November 2005 Awaiting Final Signatures!

Evaluating QM Plan Using the Improvement Plan Grid to assure that it is a living breathing document for all participating Grantees Structure through All Grantees and MO Hat-ters for ongoing update and review of Improvement Plan Grid Review Date on QM Plan on All Grantee Signature page

Challenges Training Stakeholders on the Benefits of Quality Management (QM 101) Not all grantees are on board Capacity Building with Continued Staff Turnover $$$$$$!!!!!! Engaging Providers in Change Incentives for Success

Lessons Learned Document is always evolving Organizational structure for QM helpful Relationships with stakeholders is key Process helps to identify gaps Importance of baby steps Documentation helps promote forward movement

Ms. Barbara Boshard, RN, MS Quality Improvement Team Leader Missouri Department of Health & Senior Services Section for Communicable Disease Prevention 930 Wildwood Dr., Jefferson City, MO 65102-0570 T: 573-751-6439; F: 573-751-6447 Barbara.boshard@dhss.mo.gov Rita McElhany, Interagency Liaison for HIV/STD Rita.mcelhany@dhss.mo.gov