1. Christiana Care Health Services
HIV PROGRAM
Arlene Bincsik, RN, MS, CCRC, ACRN
Program Director
Robin Bidwell, BSN, CCRC, ACRN
CQI Coordinator

2. Wilmington Hospital Annex
AI DuPont Hospital for Children
WILMINGTON
Porter State Service Center
Beautiful Gate Outreach Center
Lancaster Wellness Clinic
Smyrna Wellness Clinic
*DOVER
Georgetown Wellness Clinic
GEORGETOWN

3. HIV Program Quality Management
The HIV Program has a mature and robust quality management program that involves our physicians, clinical teams, peer educators and patient advisory groups
A comprehensive data base is maintained at all sites- “real time” data entry follows each patient encounter
Regular evaluation of data base helps us know “where our dots are”
Results of quarterly evaluations are shared with physicians and staff at each site
HIV Program is an active participant in IHI and utilizes PDSA cycles for improvement

4. PI Award PDCA Template 2005
6/24/2018
Background
Office of Performance Review conducted a site evaluation in spring of 2005
Percentage of women with documented PAP’s and subsequent appropriate follow up was established as an agreed upon performance measure
Target goal for documented PAP’s was established at 80%

5. Baseline data: WHERE IS YOUR DOT?
PI Award PDCA Template 2005
6/24/2018
Baseline data: WHERE IS YOUR DOT?
Site
Total Number of Patients
Number
of Women
% with Documented PAP results in Medical Records
Wilmington
800
320
42%
Smyrna
140 58
53%
Georgetown
260 67
57%

6. Barriers Identified: HOW TO MOVE YOUR DOT?
PI Award PDCA Template 2005
6/24/2018
Barriers Identified: HOW TO MOVE YOUR DOT?
Although the HIV Program coordinated referrals to women’s health providers, less than 10% of patients kept appointments
Potential reasons for this include:
Women traditionally put their health care needs above that of their family
Fear of finding abnormalities
Fear of accessing care in an unfamiliar environment
Geographically dispersed services in our rural sites
Lack of providers
Transportation
Overwhelming number of appointments

7. Initial Interventions
PI Award PDCA Template 2005
6/24/2018
Initial Interventions
Wilmington:
Established a nested Women’s Only Clinic at the Wilmington Hospital Annex to improve access to women’s health services and overcome some of these barriers
Ryan White Part D staff were assigned to the project and included a nurse practitioner, a primary care nurse, a pharmacist, and a social worker
Smyrna and Georgetown:
Coordinated Transportation
Provided incentives
Part D staff attended appointments with patients to outside providers
The ONLY intervention that demonstrated SIGNIFICANT and SUSTAINABLE improvement was to include pelvic exams as part of routine office visit

8. Results: Baseline and Today
PI Award PDCA Template 2005
6/24/2018
Results: Baseline and Today

9. Follow Up of Abnormal Results
PI Award PDCA Template 2005
6/24/2018
Follow Up of Abnormal Results
Nurse Practitioner certified to perform on site colposcopies has improved follow up of abnormal results at Wilmington site

10. PI Award PDCA Template 2005
6/24/2018
Path Forward
Applied for Ryan White Part D Capacity Development funds to expand follow up services in Smyrna and Georgetown Clinics
ie: Colposcopes and equipment
3 Day training course for nurse practitioners provided by American Society of Colposcopy and Cervical Pathology
Clinical supervision and Certification exam