1. Sept. 20, 2012 3:00—4:30 PM Successes in the Field – NQC Fellowship Program

2. National Quality Center (NQC)2 What does the fellowship involve? Mentorship from the NQC/HRSA consultants Conference calls among the fellows Webinars on topics you will choose Site visit(s) supported by your mentor To support you as you carry out: Field study: enriching the practice of quality among Ryan White grantees QI project: on a process that matters in your own organization

3. Fellowship Experience 2011-2012 Julia Schlueter, MPH Washington University School of Medicine

4. National Quality Center (NQC)4 Projects Local  Syphilis screening 2x a year, at least 3 months apart at Washington University School of Medicine’s Adult ID clinic National Interest Project (Field Study)  in+care Campaign Site Visits with Mentor

5. Local Project

6. National Quality Center (NQC)6 Successes Client’s last screening date and result added to weekly distribution list that nurses review Physician champion went to individual clinic sessions (At start of project and again in July) Lab now stays open during lunch Developed an algorithm for syphilis treatment Increased syphilis screening 2x a year from 36% in 2010 to 62% in 2011

7. National Quality Center (NQC)7 Challenges Buy-in from providers Rapid change and PDSA cycles – things moved a bit slower! Competing priorities for QI projects

8. National Project

9. National Quality Center (NQC)9 Planning Committee  Weekly conference calls  Input on campaign name, website, webinars topics, logo/design logistics Website  Provided feedback on outline, templates  Helped to write biographical sketches Newsletter  Journal article reviews  Provider Spotlights

10. Site Visits

11. National Quality Center (NQC)11 Site Visits Completed with Mentor – Barbara Rosa 3 Ryan White agencies  USC – MCA (CA)  LAFAN (CA)  MIHS (AZ) Participated in planning process and facilitation of site visit Observe mentor in action!

12. National Quality Center (NQC)12 Site Visits - Successes Being part of planning process Understanding goals of organization for TA and mentor’s goals Fellow leading activity and getting feedback from mentor Ability to observe different methods and tools consultant uses for common QI issues Observing multiple site visits Concentrated one-on-one time with mentor to solely focus on QI

13. National Quality Center (NQC)13 Site Visits – Common Themes Communicate about QI  Transparency is key! Supervisors need QI training Create a culture of QI Enthusiasm for QI exists, staff need direction Clearly defined Quality Manager’s role Make the QI processes sustainable Cross Training – Kathleen’s Noah’s Ark rule

14. NQC FELLOWSHIP 2011-2012 Claudia Medina, MD, MHA, MPH

15. National Quality Center (NQC)15 PROJECTS -Local Project - Viral Suppression – local agency but it became a Network effort developing in - Bring up to speed the Quality Management program for the Ryan White Part D Louisiana Network ( 10 Agencies – 4 cities) -National Interest Project - Integration of Quality Management tools, applications and dissemination through the Latino Commission on AIDS and their workshops.

16. National Quality Center (NQC)16 LOCAL PROJECT

17. National Quality Center (NQC)17 RETENTION IN CARE 64.28% VL < 200 67.08% VL < 200 67.08% VL < 48 49.07% VL < 48 49.07% OBJECTIVE: INCREASE INDICATORS BY 20% IN THE NEXT 12 MONTHS OBJECTIVE: INCREASE INDICATORS BY 20% IN THE NEXT 12 MONTHS SUCCESSES

18. National Quality Center (NQC)18 SUCCESSES Performance_MeasureJul-11Part D Jul-12GOAL CD444%62%75% Viral Load42%61%75% MV64%72%80% HAART IN AIDS65%78%90% PCP Prophylaxis22%50%75% ARV Pregnancy49%96%95% Neonatal AZT42%79%95% PCR Exposed32%57%95%

19. National Quality Center (NQC)19 CHALLENGES -Part D funds % of salaries of physicians and nurses across the State. This makes it very difficult when it comes to decide how much data is Part Ds or how much belongs to another funding. -Part D has 3 medical case management agencies without primary care on site. Nurses work at the community level but they are responsible for collecting clinical data with evidence. -LA has 64 parishes and Part D covers population in 50% of them. SNAPSHOT Total clients served 2036 100% # of active clients at the end of the reporting period 175386% # of clients shared within the network 32616% # of clients enrolled in the reporting period 79439% # of clients closed in the reporting period 36018% of clients enrolled in the reporting period that where also closed 16120% PART D OVERVIEW FOR THE FY JULY 2011 – JULY 2012

20. National Quality Center (NQC)20 NATIONAL PROJECT

21. National Quality Center (NQC)21 WHY I CHOSE THIS? Latinos make up for 16.3% of total USA population. Latinos represent 18% of HIV cases. At some point in life:  1 in 36 Latino/Latino men will be diagnosed with HIV.  as well 1 in 106 Latino/Latina women. Many factors contribute to the epidemic of HIV in Latinos. Latinos have poorer knowledge of HIV and treatment than whites. When hospitalized for HIV/AIDS Latinos are less likely to receive optimal care. Poor and less educated patients are more likely to have less effective communication……….

22. National Quality Center (NQC)22 Improvement is Possible!!! Quality improvement efforts have resulted in the reductions of other chronic disease disparities. A target intervention within a quality improvement culture may offer important lessons in disparity reduction. Programs that work with HIV-infected Latino population require culturally cultural and linguistically relevant interventions.

23. National Quality Center (NQC)23 THE PROPOSAL Was to bring quality knowledge to the Latino providers and the communities across the nation through cultural competence education. To collaborate between The National Quality Center and the Latino Commission on AIDS. The purpose of this joint effort was for the National Quality Center to train the staff of the Latino Commission on AIDS on quality methodologies and tools. The Latino Commission staff was going to incorporate the message of quality in their programs and help spread the word across the nationwide organizations that provide services to the HIV Latino community.

24. National Quality Center (NQC)24 REALITY SUCCESSESCHALLENGES We were able to communicate with the director of the LCA Keep up with the LCA agenda We identify two LCA leaders and trainers Continuity in Training We train two LCA staff at the TOT meeting in November 2011 Different MISSIONs (political/ quality)

25. National Quality Center (NQC)25 LESSONS LEARNED Concentrated time to think, breath, and do ONLY QUALITY Opportunity to study and learn more about theory and application. Great opportunity for networking in Quality. Shared and built a network of colleagues/peers in the quality world; reduced isolation Opportunity to enhance communication and presentation in quality. Learn from the experts (mentors, facilitator) Quality is much more than improvement projects, it is a life style. Learned so much about the theory and application of quality Broadened perspective of QI – looking at quality in the broader healthcare field, not just Ryan White The fellowship opened opportunities for professional development:  HIT Certification  CPHQ….

26. National Quality Center (NQC)26 Fellowship – Lesson Learned Learn from the experts Concentrated time to focus on QI GROWTH! Built a network of peers in the quality world – reduced isolation Learned so much about the theory and application of quality Networking Broadened perspective of QI – looking at quality in the broader healthcare field, not just Ryan White Professional development - including CPHQ