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

2. 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)

3. 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!

4. 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?

5. 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

6. 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

7. 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

8. 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

9. 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!

10. 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

11. 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

12. 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

13. 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
T: ; F:
Rita McElhany, Interagency Liaison for HIV/STD