Presentation on theme: "Quality Improvement Team Members"— Presentation transcript:
1Improving Viral Load Suppression Rates Easton Community HIV/AIDS Organization (ECHO) Quality Improvement Team MembersNurse Practitioner (& MD on prn basis)RNOffice ManagerMedical AssistantCase Managers
2Background Information/Rationale for QI Project Of the more than 1 million people living with HIV/AIDS in the US, 4 in 5 are not viral load suppressed.The National AIDS Strategy acknowledges the role of HIV viral load suppression in both decreasing HIV transmission and in improving patient health outcomes.Easton Community HIV/AIDS Organization (ECHO) is a Ryan White Part C provider serving Northampton, Lehigh, Monroe, Carbon, & Pike counties in Pennsylvania and Warren county in New Jersey.Client base of approximately 100 patients.100% of clients are either on Medicaid, Medicare, or are uninsured.
3Performance MeasurePercentage of patients with a viral load of <200 at last viral load testing of the measurement year
4Baseline DataPercentage of patients with a suppressed viral load (<200) at the viral load test in the measurement year:Oct. 1, 2010 to Sept. 30, %Dec. 1, 2010 to Nov. 30, 2011 – 68.57%
5Improvement GoalIncrease percentage of patients with suppressed viral load (VL<200) at the last viral load measurement of the measurement year from 66% to 85% of patients.
6Causal AnalysisWorkflow Process Analysis Identified the Following Problem Steps:No follow-up appointments scheduled for some patients with elevated viral loadNeed to develop and implement formal Adherence Program
7Viral Load Suppression Performance Improvement Measure: Workflow Process DiagramForwarded to Data Entry & to chart & flowsheetVL Received?Lab Slip Sent?SendLabSlipReminder Call if no labs in 6 weeksLabsDoneReminder LetterPreClosureLetter (no Rx’s); CM NotifiedReviewedBy NPAppt. Kept?ApptScheduled?Closure Letter at 9+ Months if no contactNYCall to ScheduleOr Resched.Discuss Next Steps –see Clinical Process DiagramPt. Referred for VL Test
8Formulate & Implement Adherence Plan IssuesIdentified?Formulate & Implement Adherence Plan2nd VL >200Consider /Do GenotypeConsider/Do Tropism & HLAB5701Evaluate for Drug-Drug InteractionsConsider or Make Med Evaluate for Drug-Adherence Assessment at Next AppointmentRecheck VL in 3 months or less2nd VL <200Adherence Assessment by phone or appt. within 2 wks.YesNoRoutineMonitoringOngoing Monitoring of Adherence & VL Testing as indicatedVL<200VL>200
9PDSA – Plan/DoChanges Planned for Process of Scheduling Patients for Follow-up VisitsAppointments previously initiated by patient after labwork completed -> now will be initiated by staff after receipt of labworkChanges Planned for Adherence ProgramInitial Adherence assessment for patient with VL>200 to be done by phone or appointment within 2 weeks (previously at next scheduled appointment) of receipt of labworkAdherence Plan Assessment Form developed to track individual patient progressMore aggressive adherence strategies:Weekly adherence evaluations of selected patients, including pill box fills and/or supervised pill box fillsInvolvement of case managers to supervise pill box fills and/or perform weekly evaluation of adherenceUse of Adherence tools, such as pillbox with alarm, cell phone alarms, etc.
10Action (Pill Box Fill, Supervison, or Check, etc.) ECHO ClinicAdherence Plan Assessment FormPatient Name:DOB:MR#:DateAction (Pill Box Fill, Supervison, or Check, etc.)AdherenceGoalAssessment(Since Last Visit)Most Recent VLResultNEXT F/UDATE