The Objective Review & Monitoring Process Presented by Rhonda Stewart, Director of Quality ImProvement Germane Solutions for DSHS HIV Care Services August 23, 2018

What is an objective review? An objective review “Is a process that involves the thorough and consistent examination of applications based on an unbiased evaluation of scientific or technical merits or other relevant aspects of the review”. Reviewers do not make assumptions or judgements during a review Germane Solutions reviewers are consistent with all External Review Organization Processes This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-NC-ND

Things to know….. Reviewers will not ‘dig’ for information, rather it should be very evident where items are throughout a client file system If your charts look like this, then your outcomes will look like this & the exit will feel like This Photo by Unknown Author is licensed under CC BY-SA

Standards & Monitoring Standards tell you what is being measured The Standards incorporate all Federal requirements and DSHS policies If one component is missing when monitoring, the indicator is not met This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY-NC-SA

Service Standards https://www.dshs.texas.gov/hivstd/taxonomy/#section6

Monitoring tools https://www.dshs.texas.gov/hivstd/taxonomy/#section6

Why do we monitor? Monitoring is a program requirement for all Ryan White federal funded programs Germane Solutions conducts the quality assurance monitoring for DSHS HIV Care Services Group to determine provider compliance with the Standards Providers are then able to determine quality improvement processes that will enhance their compliance with the Standards that ultimately will improve the client system of care

Tips to prepare Have all items available and ready for the review team before the site visit Look at the dshs monitoring tools alongside the respective dshs service standard to understand numerators/denominators that determine the outcome for the indicators listed in “performance measures” Breathe…..monitoring is a process to help with improvement initiatives

Recommendations for 2019 – Thoughts? Randomized client lists – send directly to providers Should we send 2 weeks or 1 month prior Impact of sending 1 month prior = not a full 12-month review period for rolling review Reports Include recommendations discussed during exit Indicate trends seen (e.g., # of charts that were missing third party verification in eligibility, etc.)

Sample Size for 2019- changes 1. change to the sampling methodology for most service categories similar to the HOPWA tier system Reduce the sampling burden for sub-recipient chart pulls Provides a significant outcome result –additional charts can be pulled when a trend can not be established with the minimum number of files Follows HRSA guidance

Unduplicated Client ID per service category Proposed Sample Size guidelines 01 – 24 = 100% of files 25 -- 50 = 25 randomized files 51 – 100 = 30 randomized files > 100 = 40 randomized files

Sample size 2019- what stays the same 2. Continue to use the confidence level/interval sampling of 80% +/- 8 for the following: Universal standards OAHS Oral Health MCM and NMCM Most funded service categories Ensures outcomes are statistically reflective of the population Closely linked to viral load

Monitoring Data Base Access and 2019 role out

Data Base access Report Viewing privileges User name and password- only for AA use at this time Training and TA on how to run reports AA’s will be able to see all data- including other regions

2019 Schedule role-out On-site training and TA to enter monitoring data directly into the database Training role-out ongoing for calendar year 2019- intent to develop training calendar by end of 2018 Very tentative- First role-out between January and July: BVCOG, STDC, TRG and Lubbock Second role-out between August and November: Bexar, Dallas, Tarrant and we can include Austin and Houston if interested. AA’s must continue to use the excel monitoring tools until their monitors are trained to use the data base for 2019 reviews This is an implementation year- anticipate issues and practice flexibility