Bob Holtkamp, HIV Program Coordinator Missouri Department of Health and Senior Services Bureau of HIV, STD, Hepatitis 930 Wildwood Drive Jefferson City, MO 65101 bob.holtkamp@dhss.mo.gov 573-751-6439 86,408 PLWA – reported in the 8 states At least 43,000 PLHIV – estimated TOTAL POTENTIAL IMPACT: IMPROVING THE QUALITY OF CARE FOR 129,000 PLHIV/AIDS -- >10% of PLHIV/AIDS in United States

Quality Management WorkGroup 5 members from Part A (KC & StL) 2 Supervisors, Clinical Consultant, Grant Administrator, Quality manager 10 members from Part B 4 QSM, ADAP Director, Planner, Surveillance, Educator/Trainer, Coordinator 3 members from Part C 2 Clinic Directors, Quality manager 2 members from Part D Clinical Director, Quality Manager Monthly 2 hour Teleconferences on 4th Thursday at 9AM to 11AM except no meeting in July and December.

The Four Domains Improving Access to Care and Retention in Care Reduce Health Disparities Improve Quality of Health Optimization and Management of Resources

Missouri HIV Case Management System 1 Statewide case management system with same standards and policies All Ryan White grantee funded case managers participate (Parts A, B, C and D) Personnel include: 3 DHSS Regional Quality Service Managers(QSM) 34 agencies with 78 contracted case managers 3 Transitional case managers for Corrections 1 Statewide Case Management client level data system (FACTORS)

Priority for 2007 Missouri’s Quality Management Plan is focused on the key activities of Medical Case Management Examples of Key Activities Assessment Individual Service Plan (ISP)

Annual Assessments DOMAIN: Improving Access to Care and Retention in Care MEASURE: The percent of case management clients assessed annually. STANDARD: Assessment and Evaluation is a collaborative, client-driven process between the case manager and client where progress is reviewed jointly and the plan of care is amended based on interactions between the client and case manager. FREQUENCY OF MEASURE: Monthly GOAL: 95% completion rate

Annual Assessment Measured by statewide, by region, by agency, by case manager Is it process or is it people?

Individual Service Plans (ISP) Conversion of written ISP to electronic ISP DOMAIN: Improving Access to Care and Retention in Care MEASURE: Percentage of active case managed clients with electronic Individual Service Plans (ISP). STANDARD: A Plan of Care will be developed through a collaborative process between the case manager and each individual HIV+ person… FREQUENCY OF MEASURE: Quarterly GOAL: 95% completion rate

Individual Service Plans by Statewide Measured by statewide, by region, by agency, by case manager

Individual Service Plans October 2006 Baseline by Region

Individual Service Plans January 2007 by Region

Individual Service Plans April 2007 by Region

Challenges Difficulties with analyzing data? Learn the data fields to ensure that the correct data is used for measurements. Follow-up problems? Ensure standardization of entry (training, drop downs, etc..) Develop consistency in report query process (write it down and know what you are measuring and why) Sustainability issues? Assign responsibility for each measure Assure on-going investment for upgrades and expansion of data system Difficluty example Income vs FPL

Lessons learned Articulate the standard to everyone Communicate the measure and it’s importance to all audiences Reassure personnel at all levels Clarity of process and reporting Provide educational support of case management system (3 CM educator/trainers) Create and sustain climate of performance Agreement on level of measurement – If perfection is unattainable, what is quality?