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

2. 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
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3. 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
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4. 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
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This Photo by Unknown Author is licensed under CC BY-NC-SA

5. Service Standards

6. Monitoring tools

7. 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

8. 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

9. 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.)

10. 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

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

12. 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

13. Monitoring Data Base
Access and 2019 role out

14. 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

15. 2019 Schedule role-out
On-site training and TA to enter monitoring data directly into the database
Training role-out ongoing for calendar year 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