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

2. 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.

3. 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

4. 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

5. 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

6. Results

7. 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

8. 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

9. 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

10. 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