1 Understanding and Using Your HIVQUAL Data March, 2011 HIVQUAL Workshop.

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Understanding and Using Your HIVQUAL Data

March, 2011HIVQUAL Workshop

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Agenda

The National AIDS Strategy And the HIVQUAL Process

Generating eHIVQUAL Data Validation Reports

Dashboard and Sharing Data to gain buy in for Quality

Analyzing Aggregate Data Report Large Group Discussion

(9:15 – 9:30 AM)

(9:30 – 9:40 AM)

(9:40 – 10:00 AM)

(10:00 – 10:30 AM)

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Agenda Continued

Brainstorming Improvement Small Group Exercise

Generating Data Reports by Specific Demographic Points

Analyzing Data Reports by Specific Demographic Points Small Group Exercise

Evaluation

Finish

(10:30 – 11:00 AM)

(11:00 – 11:30 AM)

(11:30 – 11:50 AM)

(11:50 AM – 12:00 PM)

(12:00 PM)

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How can NYSDOH AI Quality of Care Program Support the National HIV/AIDS Strategy?

Establish a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV.

Increasing access to care and optimizing health outcomes for people living with HIV; and,

Reducing HIV-related health disparities.

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National HIV/AIDS Strategy

By 2015:

Increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20 percent.

Increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20 percent.

Increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20 percent

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National HIV/AIDS Strategy

Increase the proportion of Ryan White HIV/AIDS Program clients who are in continuous care (at least 2 visits for routine HIV medical care in 12 months) from 73 percent to 80 percent.

Increase the percentage of Ryan White HIV/AIDS Program clients with permanent housing from 82 percent to 86 percent (from 434,000 to 455,800 people). This serves as a measurable proxy of our efforts to expand access to HUD and other housing supports to all needy people living with HIV.

Increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65 percent to 85 percent.

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National Strategy contd.

1.1 Ensure that high-risk groups have access to regular viral load and CD4 tests: All persons living with HIV should have access to tests that track their health, but more must be done to make sure that these tests are available to African Americans, Latinos, and gay and bisexual men

Measure and utilize community viral load: Ensure that all high prevalence localities are able to collect data necessary to calculate community viral load, measure the viral load in specific communities, and reduce viral load in those communities where HIV incidence

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How can NYSDOH AI Quality of Care Program Support the National AIDS Strategy?

Optimal clinical care should include a range of integrated clinical and preventive services to reduce HIV-related morbidity and mortality.

Patient-centered care–defined by the Institute of

Medicine as health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences–should be the standard.

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Actions are based upon accurate and measured data.

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Infrastructure

HIVQUAL Model - Overview

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HIVQUAL Model - Overview Goal to assist health care facilities in developing a

quality infrastructure that supports ongoing quality improvement activities.

Emphasis on sustainability by focusing on the structural programmatic and implementation level.

Practical guide for all HIV programs, regardless of their service delivery model, patient caseload, or site location.

Developed by the New York State Department of Health AIDS Institute in collaboration with HIVQUAL consultants.

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HIVQUAL Model – Program Cycle

Step I: Develop and Plan an HIV Quality Improvement Program

Form a quality improvement committee Develop a quality improvement management plan Strategize to implement the quality plan, develop a

workplan Step II: Facilitate Implementation of HIV Quality

Improvement Program Establish performance measurement systems Establish improvement project teams Build support for the HIV quality program

Step III: Evaluate HIV Quality Improvement Program Evaluate HIV quality program effectiveness and facilitate

future planning Evaluate project team performance Strategize to sustain HIV quality program and its activities

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Develop and Plan a Quality Improvement Program


Evaluate HIV Quality Improvement Program


Facilitate Implementation of HIV Quality Program


Step 2: Develop a Project Team Workplan


Step 5: Project Team Evaluates Result(s) with Key Stakeholders


Step 3: Project Team Investigates the Process


Step 1: Review, Collect and Analyze Data


Step 4: Project Team Plans and Tests Change(s)


Step 6: Systematize Change


HIVQUAL Model

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HIVQUAL Model

Plan

DoStudy

Act

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Questions for Data Follow-up

What are the results for key indicators? What are the major findings based on the generated

data reports and your data analysis? What is the frequency of patients / programs not

getting care? What is the impact of not getting the care? How does the performance compare with

benchmark data? What is the feasibility of improving the care?

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Key Questions for Data Follow Up (Cont’d)

How can you best share the data results with your key stakeholders (Part A/B QI committees, HIV providers, consumers, etc.)?

How do you generate ownership among providers and consumers?

How will you assist in initiating/implementing QI projects to address the data findings? Who will be responsible and what are the next steps?

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Act

What changes are to be made?

Next cycle?

PlanObjectiveQuestions and predictions (why)Plan to carry out the cycle (who, what, where, when)

Study Complete the

analysis of the dataCompare data to

predictionsSummarize

what was learned

DoCarry out the planDocument problemsand unexpectedobservationsBegin analysis of the data

The PDSA cycle for learning and improvement

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HIVQUAL Model – Project Cycle

Step 1: Review, Collect and Analyze Baseline Data

Step 2: Develop a Project Team Workplan Step 3: Investigate the Process Step 4. Plan and Test Changes – PDSA Cycles Step 5: Evaluate Results with Key

Stakeholders Step 6: Systematize Change

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11:15eHIVQUAL Data and Reports

o Generating eHIVQUAL Data reports: Data Verification Report Dashboard Aggregated Data Management Reports Individual Quality Indicator Reports Quality Indicator results by race, gender,

ethnicity, age

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Exporting all eHIVQUAL Reports

You can export your reports directly to your computer in various formats for printing, etc.

To export as an Excel*: Step 1: Once your report is loaded, select “Excel”

from the dropdown list labeled “Select a format” in the top left-hand corner.

Once you have made your selection, click on “Export”.

Open and save the file to your computer as with any other download.

* Repeat for file types PDF, CSV, etc.

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Data Validation Report

Step 1: When logged into eHIVQUAL, click on the “Report List” tab (top left-hand corner).

Step 2: Under “Select a report” click on “Detailed Data Validation”.

Step 3: Under “Review Period” select the dates of the review (1/1/09-12/31/09).

Step 4: Click on “Report”, on the bottom left-hand corner.

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Data Validation Report Example

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Dashboard


Step 2: Under “Select a report” click on “HIVQUAL Dashboard”.


Step 4: Click on “Report”, on the bottom left-hand corner.

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Dashboard

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Elements of the Dashboard Reports

After generating your Dashboard, click on “Visit Distribution” below the corresponding image*:

*Repeat for “CD4/Viral Load Monitoring”, “Diabetes Management”, “Viral Load Suppression” and “Mental Health Components”.

Click here

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Dashboard – Visit Distribution

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Elements of the Dashboard Reports cont.

To generate the TB report within “Screening Indicators”, click on the top, red bar on the graph.

Screening Indicators (within review period)

*Repeat for “Substance use”, “Tobacco”, “Pap test”, “ Dental”, “Syphilis” and “Mental Health”.

Click here

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Dashboard – TB

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Aggregate Management Reports


Step 2: Under “Select a report” click on “Aggregated Management Report 1”.*


Step 4: Click on “Report”.* Repeat for Aggregate Management Reports 2 – 5

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Aggregate Management Report # 1

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Using Reports for QI

Individually review data results from Aggregate Management Report 3. What areas scored well across all

facilities? What areas scored well across some

facilities? In what areas did all facilities receive low

scores? What does this suggest?

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Scenario You are the HIV QM of an HIV Primary

Care Provider with 3 distinct clinics where HIV Service is provided. After completing your eHIVQUAL Review, you generate the Aggregated Management Report 3. What ideas for improvement activities does the

report suggest? Small Group Work: Brainstorm possible QI

activities. How would you measure the success rate?

Report back to larger group.

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Generating reports by demographic points

Step 1: After clicking on “Report List”, select the report type, review period, and sites (if applicable).

Step 2: Make selections for further demographics.

For CD4/VL, use the drop down list to select either “ALL”, “Lowest CD4 <=” or “Highest CD4 >=”. Type the value of your desired cutoff.

Example: “Lowest CD4 <=”, 50

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Generating reports by demographic points cont.

Step 2 cont: Make selections for further demographics.

For Gender, select either “ALL”, “Female”, “Male” or “Transgender”.

For Age, select either “ALL”, “Over” or “Under”. Type the value of your desired cutoff.

Example: “Under”, 35

For ARV Therapy, select either “All Included” or “On ARV Only”.

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Generating reports by demographic points cont.

Step 2 cont: Make selections for further demographics.

To filter by Race, State, Risk, Type (Facility) and/or Title (Ryan White) use the dropdown list labeled “1:”.

Example: Select Race. Then select “Selected”. Select “White non-Hispanic”, “Black non-Hispanic”, etc.

NOTE:You can simultaneously filter by two of the following: Race, State, Risk, Type (of facility) or Title (Ryan White). Select the second demographic in dropdown list “2:”

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Viral Load Suppression Dashboard Report – All patients

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Viral Load Suppression Dashboard Report – Filtered by Risk - IDU

Highest VL during review period

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Viral Load Suppression Dashboard Report – Filtered by Risk/MSM and Race/Hispanic & Black non-Hispanic

Highest VL during review period

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Viral Load Suppression Report Use for QI

After reviewing these reports, what activities for improving the quality of care do you suggest?

Small Group Work: Brainstorm possible QI activities based on data results.

Report back to larger group.

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Contact information:

If you have any questions or would like to request TA/Coaching at Your site on using data for QI, please contact: Dan Belanger

(212) [email protected]

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Special Thanks to:

Bruce Agins, MD MPH Christopher Wells Amanda Bowes

1 Understanding and Using Your HIVQUAL Data March, 2011 HIVQUAL Workshop.

Documents

proportion of hiv

hiv incidence

hiv diagnosis

undetectable viral load

continuous care

community viral load

routine hiv medical

regular viral load