CAMBA QI PROJECT Improving Clients’ Involvement In & Documentation of Medical Care ANGELES DELGADO November 14 th, 2006

REASON FOR THE PROJECT Review of Current Process:  chart progress notes indicate little (documented) emphasis on discussion of client’s health  few questions regarding medical appointments kept, blood work done, compliance with medication, issues with medication etc.  progress notes mostly reflect monitoring of housing, benefits, legal and other issues.

Changes To Be Tested Changes To Be Tested DEVELOP NEW POLICY ACROSS ALL HIV PROGRAMS AND TRAIN STAFF:  At Least twice per month – staff will discuss & document whether the client is connected to medical care & how the client is feeling  Progress note was changed to include questions regarding client’s connection to medical care  Staff will document how their clients are feeling with details (“so-so” is not enough)  Training will focus on the important role that CM play in assisting clients with connecting to and maintaining medical care.  Clinical supervision will provide support to address the changes

DATA COLLECTION PLAN Definitions: “encounter” = any documented discussion (face-to-face or via phone) with a client “medical compliance” = at a minimum, documentation that the client is keeping/maintaining medical appointments 1. Developed a tracking tool to collect # of encounters and medical compliance 2. Program supervisors collected data on a monthly basis as a part of routine chart review 3. Number of successful encounters and medical compliance was evaluated for four months and re- evaluated at 6 months after the intervention

Where are we starting?  At Baseline: 10% of charts reviewed for the month of February 2006 had documentation regarding the client engagement in medical care & their health status

Results

EVALUATION Documentation of medical compliance improved from: Documentation of medical compliance improved from: 10% at baseline to 100% & 95% 100% & 95% 3 months & 4 months Post-Intervention

Sustaining the Improvement? August – chart audit to monitor whether the changes were being sustained revealed a drop in documentation of medical compliance to: August – chart audit to monitor whether the changes were being sustained revealed a drop in documentation of medical compliance to: 71% of charts indicated one note of medical compliance 59% of charts indicated 2 or more notes of medical compliance

LESSONS LEARNED Time constraint in reviewing charts Time constraint in reviewing charts Some clients did not want to discuss their medical/health issues twice per month. They didn’t want to be reminded of their illness. Some clients did not want to discuss their medical/health issues twice per month. They didn’t want to be reminded of their illness. There are many competing/pressing issues occurring with clients (housing, immigration, childcare...). At times, these take priority for clients There are many competing/pressing issues occurring with clients (housing, immigration, childcare...). At times, these take priority for clients

Next Steps Change policy to: Change policy to: At Least once per month – staff will discuss & document clients’ medical compliance and health status - how the patient is feeling  Continue to emphasize the importance of client engagement in medical care through supervision & training  Consider reviewing a random sample of charts per month, rather than the entire client population seen in the month