1. New Jersey Family – Centered HIV Care Network  Lead Agency New Jersey Department of Health  Mission- provide comprehensive, culturally sensitive, coordinated care for women, infants, children, youth and families with HIV infection  Network offers HIV specialty care, medical case management, access to clinical drug trials, social service support, outreach, counseling and testing, and family case management  2,498 Part D clients were served in 2012  The Part D Statewide Network consists of 7 HIV clinics and their satellites sites; Cooper Hospital, Camden; The FXB Center, Newark; Jersey City Medical Center, Jersey Shore Medical Center, Neptune; Newark Beth Israel Hospital, Robert Wood Johnson Medical School, New Brunswick; St. Joseph’s Hospital and Medical Center, Paterson Ellen Dufficy, Nurse Consultant NJ Ryan White Part D 609-777-7795 * * * * * *

2. QI Project: Pap Screenings Team Members: Multiple disciplines from all 7 Network agencies and consumers Problem Statement: The 2012 Network rate for annual Pap screens for all HIV+ patients over the age of 18 is 83%, which surpasses the Network quality benchmark rate of 75%. However it does not meet the IHI national quality benchmark rate of 90%. This indicates that the Network needs to further improve upon Pap screening rates to achieve the national standard. Although the Network’s average has surpassed the Network goal, as we drill deeper into the data only two of the seven Network sites individually met or surpassed the 75% rate. In addition, the 2012 Network rate reaches only 65% when calculated using the electronic database rather than through the use of on-site chart reviews. Goal: By February 28, 2014, the Network will realize a 75% rate for Pap screens at each of the seven sites, when calculated via an on-site chart review or the site’s electronic database. HAB HIV Core Clinical Performance Measure: Percentage of women with HIV infection who have a Pap screening in the measurement year

3. Meet with Gyn clinic staff and consumer QI representative to develop plan to better engage women with HIV in Gyn care through better service coordination efforts Save 4 open Gyn slots twice a week for walk-ins from the HIV clinic. Schedule those women who need Paps for those time slots at HIV clinic. Upon arrival at HIV clinic, walk patient over to Gyn clinic for a Pap, then return them to the HIV clinic for the HIV exam Note the number of women each week who get a Pap. Compare these data to weekly average before intervention. Note any barriers or reasons why women still do not access Gyn care As intervention proves to be successful, use consumer advocates instead of HIV staff to walk patients through both clinics Plan Do Study Act Problem Statement: The Pap rate for women 18 years of age and older is lower than the expected standard of care. Although women are routinely referred for Gyn care, they do not keep appointments Strategy: Use a multidisciplinary team approach that crosses Parts, utilizes collaboration and includes consumers, to optimize scheduling flexibility and remove patient barriers to access to Gyn care  NJ participated in HAB/NQC Quality Management Learning Collaborative in 2008  NJ Cross Part Collaborative initiated October 2008  Formed multidisciplinary group across Parts, began to look comprehensively at HAB measures. Three 18 month phases of Network data have been collected and reviewed by the Network through PDSA cycles Methods and Tests Sample PDSA cycle

4. Measures The Network will realize a 75% Pap rate at all 7 sites February 2012- April 2013 Phase 3 cycle reports, RWPD Network aggregate data abstracted from electronic systems. June 2013 data report remains pending at this time. June 1- May 31 annual chart audit RWPD Network aggregate reports

5. Results  Although improved Pap rate to 65%, not quite where we need to be yet  Network agencies demonstrate strong commitment to continue the project, including AETC provider training for on site Paps  Phase 4 of CPC will convene in June 2013 and Pap is likely to remain the QI focus for Part D Network and CPC 2010 Part D Pap rate 44% 2011 Part D Pap rate 62% 2012 Part D Pap rate 65%