1. end+disparities Learning Exchange: Greater than the Sum of its Parts June 15, :00-2:30 pm ET Michael Hager & Judy Popkin, NQC Christine Kibui, California Department of Health Lara Jackson, CommHealth Katelin Thomas, SUNY Stony Brook
Michael
Welcome to our June end+disparities Learning Exchange Webinar.
On behalf of the National Quality Center, we are excited to continue onward with the end+disparities Learning Exchange; one of our most innovative and important improvement initiatives to-date in partnership with the HRSA HIV/AIDS Bureau.
Partners in+care is the consumer involvement aspect of the Learning Exchange. Over the course of the exchange, we will focus in on how to involve the consumer community in this important work based on our monthly overall topics.

2. Before we start… Please type your name, organization, city and state in the chat room
Michael
Please note that this webinar is being recorded for later replay by those who missed the call.
Before we start our webinar, let’s take a moment and ask participants to introduce themselves via our chat room, which can be found on the right hand side of your screen, just underneath the participants section. There is a small box labelled Chat.
Please enter your name, organization, city, and state so others can see who we have on the call today.

3. Ground Rules for Webinar Participation
Actively participate and write your questions into the chat area during the presentation
Do not put us on hold
Mute your line by pressing the microphone button to the right of your name
Please complete the post-webinar evaluation
This call is recorded for replay for those who missed the webinar
Michael
Ground rules for todays webinar:
- Actively participate and write your questions into the chat room; we have several staff and consultants who will answer your comments – I want to thank them and HAB representatives
- Please mute your phone line; you can press the microphone button to the right of your name
- Please complete the post-webinar evaluation, which will be sent to your at the conclusion of the webinar. We look forward hearing from you.
- As stated earlier the call will be recorded for replay for those who missed the webinar

4. The end+disparities Learning Exchange a 9-month initiative that promotes the application of improvement interventions to reduce HIV-related disparities in four key subpopulations while building and sustaining a community of learners among Ryan White HIV/AIDS Program recipients. The Learning Exchange offers informational opportunities by content experts and utilizes the power of peer learning to facilitate local improvement efforts on eliminating HIV-related disparities.
Michael

5. Communities of Learning: collaborative, QI campaign, Regional Groups
Consultation: On/off-site coaching of recipients to advance their clinical quality management programs
Together, we can make a difference in the lives of people with HIV. NQC provides assistance to RWHAP recipients to improve HIV care since gaps in HIV care still exist and advances are uneven across HIV populations.
250 recipients participated in 28 Regional Groups
51% of all recipients joined the largest HIV QI campaign; viral suppression increased from 70% to 76%, a statistically significant improvement
Training and Educational Fora: monthly webinars, advanced trainings, online QI tutorials
40% of RWHAP recipients received TA and 95% would recommend TA to others
40 online QI tutorials are available; over 35,000 have been taken so far
Intensity
Information Dissemination: monthly newsletters, websites, publications, exhibits, QI awards
Michael
NQC is funded by the HRSA HIV/AIDS Bureau since 2004 and provides technical assistance to all RWHAP recipients to build their sustainable clinical quality management programs. Over 90% of all recipients have accessed intensive NQC offerings and take advantage of our various services. The Learning Exchange is an extension of these offerings.
As you see in this graphic, NQC provides opportunities
To participate in monthly webinars to learn more about QI – next week’s webinar focuses on the 2016 NQC Award winners
To attend our 4 3-day face-to-face training programs or take one of 40 online tutorial we have available
To request onsite assistance by our pool of QI experts
To join one of our 28 Regional Groups, a local community of learning
If you would like to learn more, please visit our website at NationalQualityCenter.org.
over 90% of the 587 RWHAP recipients accessed NQC services
~1,300 individuals (61% of recipients) graduated from 45 three-day advanced trainings
NationalQualityCenter.org |

6. Agenda Welcome & Introductions What is Spread?
Spreading Session – RWHAP recipients and subrecipients share their work
General Discussion and Q&A
Adjourn
Judy
Our webinar today is focused on making sure learning we have in the field is spread around the RWHAP provider and consumer communities. After that, we will open up the webinar for your questions in our Q&A session.

7. Learning Objectives
Explain what spread is and its importance in QI work.
List three things RWHAP providers have done around the country to achieve health equity.
Explain 1-2 next steps your agency can take to continue advancing quality around health equity.
Judy
Read the learning objectives.

8. What is Spread? Judy and Michael tag team:
M: Ask the audience if they know what we mean – have someone (or maybe two if the first response is short) explain what they think.
J: Tell the audience that spread is making sure that the work we do is communicated within our broader community so they can learn from it, too. For example, it’s easy to close shop and move on to something else when we finish a QI project, but it’s best to complete a write-up or produce some other accessible media around what you did, how you did it and what you learned. Save it online! Send it in a newsletter! Share it on a bulletin board! Speak on it at a conference, in an abstract, or in a piece for the literature!!
M: Clemens, anything to add?
Continued on next slide…

9. Details on Spread Remember Your Sustainability Plan??
May 18 and 25 discussions emphasized the importance of sustainability and having a plan to go about that
Include prompts and context on spread for your project in the sustainability plan
Who are you sharing it with?
When?
How?
For what purpose??
M: think back to our discussions in May… or check out the recordings later on! We talked about the importance of having a written sustainability plan that you can generate as part the project planning and strategic thinking exercise. Include this in your plan!!
J: exactly! Think of the opportunities you’ll have to spread your work and think strategically about how when and why you share certain details in certain ways. For example, you could produce an info graphic to share with consumers so they can take it to the other places they receive their care for discussion. You could write a scholarly article or an abstracts to share through academic channels in journals and at conferences at various levels. You can create a new training module that all new staff (and perhaps new cross-agency regional group members) can use to come up to speed on new or adjusted practices.
M: Clemens, anything else to add?
J: Does anyone have any examples of a project they spread and how they went about that? We are about to hear from several RWHAP programs on their projects… guess what… by their sharing their projects with us all here, this is part of spread for their projects! Get it?

10. Lara Jackson Quality Improvement Specialist Tacoma, WA
Judy, introduce Lara who will talk about her work in Tacoma WA:
Lara Jackson is the quality improvement specialist at Community Health Care in Tacoma, WA. She has years of experience in clinical quality management across a number of settings. Today she is sharing the work at her agency in Tacoma, WA focused on reducing disparities in HIV care.
Lara - Here are some talking points – basically a paste of your submission for action week (7 minutes)
No disparity specific project, rather disparities analysis is fed directly into ongoing projects around intake, eligibility, MH/SA screening, and retention processes
At one of our clinical team meetings we watched the short End Disparities YouTube video and then entered our VS and retention numbers for the four key groups into the disparities calculator together. We identified significant disparities with our youth and our Latino MSM,  and a less significant disparity for our trans population. Our population is small, so I was able to do chart reviews on our non-VS individuals in these groups and pull out key themes. I identified themes of trauma, unstable housing, and substance use/mental health issues across categories and brought these back to the team.
I used the calculator to confirm significant disparities for those experiencing  unstable housing, our Medicaid/<100% FPL population, and those requiring intervention for depression and/or active substance use issues as identified by their most recent screening scores on the PHQ-9 and DAST-20. I presented a visual representation of our VS by category to our QI committee, which seemed to help us all understand our range of VS. We discussed which disparities were significant. I attached it for you to get an idea.
We had a trauma-informed care training that helped our staff understand better how our patients’ trauma can impact their ability to engage in care.
We used information from the trans webinar in our efforts to advocate for trans-inclusive care at the larger organizational level (SOGI collection, etc.)
We’ve had discussions about youth disparities with our local case management agency and health department to make sure we are all paying attention to this vulnerable group. We recently had a 10-yr old enroll in our program – our first patient in that age range—and I brought information I had learned from the youth webinar into our discussions around what we would need to serve her well.
We discuss disparities with our consumers during educational groups and with our new consumer advisory group.
We’ve requested additional funding from HRSA for a Part D-specific social worker for the upcoming year. Our team is very small and we currently have no social worker/case manager and have come to a consensus that we need someone on site, on our staff, filing that role. The disparities focus helped us to identify which populations will be the focus for this new position.
We’re looking at how to fill gaps in our ability to provide support to those dealing with mental health issues and substance use disorders. We have a part time therapist but recognize we need additional staff – social worker, CDP, behavioral health interventionist, etc.—to support our HIV Clinician in providing the ‘BIRT’ part of SBIRT as need is identified through screenings and conversations.
So basically Antoinette (our Program Director) and I have been using this process as an opportunity to identify disparities and associated unmet needs and using that information in ongoing program development rather than a specific QI project or intervention. We’re also using it to spark discussion and learning among our team.

11. Katelin Thomas SPARC Project Coordinator Stony Brook, NY
Judy, introduce Katelin who will talk about her work in Long Island, NY:
Katelin Thomas is the SPARC Project Coordinator at Stony Brook University on Long Island. She is heavily involved with their Part D funded program and leads the development and implementation of evidenced based strategies to improve patient performance along the HIV care continuum. She is a big believer in meaningful consumer involvement and has a very impressive story to tell in terms of her work in Long Island.
Katelin- Here are some talking points – basically pasted from your submission for action week! (7 minutes)
Stony Brook University’s Consumer Advisory Board (CAB) has been actively working with program staff to identify and address disparities. At our 11/21/16 CAB meeting, staff provided preliminary results of a recently completed HIV+ patient survey and a detailed review of Stony Brook’s 2015 Care Cascades (retention and viral suppression data for the entire Designated AIDS Center was further broken down by clinic, gender, race, ethnicity and age – allowing us to identify disparities). At our 3/27/17 CAB meeting, staff provided final results of our 2016 consumer surveys (with results broken down by clinic, language spoken, gender and age) as well as a detailed review of Stony Brook’s 2016 Care Cascades (with results broken down clinic, gender, race, ethnicity age and mode of transmission). CAB members and program staff compared results of the 2015 and 2016 cascades and discussed possible reasons for the disparities identified. Staff discussed interventions that might impact on these disparities, such as targeting our self-management program classes towards specific subpopulations and implementing a one-time incentive program. While our CAB generally meets quarterly, it was agreed that we would hold a meeting the following month to develop recommendations for areas of improvement that would be presented to the leadership of both the Adult and Pediatric/Adolescent HIV clinics at the June CAB meeting. At our 4/24/17 CAB meeting, CAB members generated a list of recommendations based on the consumer survey results and the 2016 Care Cascades. These recommendations covered commonly identified areas for improvement, specific recommendations related to wait times, general recommendations for all clinics, recommendations specific to care for those who receive their non-HIV-primary care in Family Medicine or Internal Medicine, and recommendations related to disparities apparent in the Care Cascades. In addition, the CAB members identified specific questions that they would like to ask of the physician in charge of the Adult ID clinic. A typed list of the CAB’s recommendations has now been distributed to all CAB members and will be used to guide the discussion between CAB members and senior HIV program leadership at our next meeting to be held 6/26/17.

12. Christine Kibui Clinical Quality Management Consultant Sacramento, CA
Judy, introduce Christine who will talk about her work across the state of California:
Christine Kibui is the clinical quality manager for California’s Part B program. She is still relatively new in her role, but has been eager to dig into this work and to make a difference in the lives of people living with HIV in her state. As we all know quality improvement can feel like a cha-cha (two steps forward, and one step backward), but the most important thing is the framework we use to identify opportunities for improvement and the selection of interventions to bring about that improvement.
Christine - Here are some talking points (7 minutes)
Using the unlocked calculator in CA has shown that the youth (13-24) are the group most affected by health disparities.
New Buddy system being established where we connect folks with scores les than 80% with folks with scores greater than 80% for viral suppression .
New Learning Network system being established across the state to regionalize and enshrine peer learning systems in CA
PS – you all are just starting out with this… it’s totally ok if you don’t use all 7 minutes, but definitely please feel free to provide additional context around your interventions and your planning around all this. It’s amazing to see CA take this bull by the horns!

13. Discussion Session Judy
Is there anyone else on the line who submitted for ACTION WEEK that would like to share what they did?
(ask Michael if there are any submissions he’d like to highlight).
Hopefully we still have time for questions. Have we had any questions in the chat room that haven’t been answered? OR are there any themes from the chat room we want to bring out into the open discussion?
Has anyone had any AHA moments today?
Has anyone learned anything that they want to apply in their own care settings (either as a provider or a consumer)?

14. Next Steps and Activities in end+disparities
Coming Up!
Next Steps and Activities in end+disparities
Michael

15. Partners in+care Roundtable Discussions
Each date is a clickable link with additional information to save in your calendar!
June 22: Greater Than the Sum of its Parts
Michael
Each month we focus on another topic. Partners in+care roundtables will occur on the fourth Thursday of the month from 1-2pm ET. Our final partners in+care round table through this initiative will take place on Thursday June 22 at 1pm Et.
When we develop content for consumers to join the discussion, we’ll be sure to focus in on our challenges and opportunities in each area and will explore ways consumers can get involved in the work. The main toolkit available to us is the Partners in+care toolkit presented today, but there is plenty of room to introduce new tools and resources that are of interest to you

16. Office Hours Journal Club!
June 23, 2017 at 1pm ET
Fox et al. The Many Roles of the Social Worker in Shaping the Quality of Care in Transdisciplinary Teams As We Get To Zero
Meeting Objectives: Define transdisciplinary team. Describe the social worker’s role in transdisciplinary teams. Explain how social work, transdisciplinary teams, and quality management get us to zero.
Michael

17. Closing Remarks
Michael hands to Judy then back to Michael

18. end+disparities Video
Visit our NQC YouTube channel to see our 3min video about disparities in HIV care -
Michael
A reminder to check out our video and the website!
Another cool informational tool that we have developed is a short animated video about disparities in HIV care and outcomes. Please take a look and feel free to share with others. 18

19. THANK YOU!
Michael

20. 212-417-4730 NationalQualityCenter.org Info@NationalQualityCenter.org
Michael 20