1. 2012 NYS HIV Quality of Care Program
Learning Network QI Project Updates

2. Quality Improvement Project Focus
Adolescent Quality Learning Network-VL Suppression & Transitioning Care
Substance Use Learning Network-VL Suppression
Community Health Center QLN-VL Suppression & Retention
HHC QLN-Linkage to care, retention & VL suppression

3. Psycho-Social Support
Secondary Drivers
Primary Outcome Primary Drivers
Housing
Substance Use
Psycho-Social Support
Mental Health
Appointments
Increase the viral load suppression rate by 10% across clinics over a 10 month period
Retention
Transportation
Continuity of care
Staff attitude
ARV Adherence
Treatment Education
Health Literacy
Health Insurance

4. Network Viral Load Suppression QI Project
2012 Community Health Center Quality Learning Network Viral Load Suppression QI Project
Network Viral Load Suppression QI Project
9/7/12
Dan Belanger Team
IHI IA Score: 3.5
Predicted Score by 12/31/12: 4.1

5. Community Health Center Quality Learning Network HIV Viral Load Suppression QI Project
Psycho-Social Support
Retention
Appointments
Housing
Substance Use
Transportation
Continuity of care
Mental Health
Case management/
SW Support
Staff attitude
Staff/patient communication
Improve the VL Suppression rate by 10% across 7 community health centers by 12/31/12
Patient support network
Treatment education
Clarity of purpose-goals, roles, responsibilities
Clinic QM infrastructure
Health literacy
Health insurance
Clinic environment
Self efficacy
Staff communication
Clinic flow
consumer involvement
Clinic system/processes
ARV Adherence

6. GHV – 8 patients IFH – 47 patients OD – 9 patients
# whose most recent VL during the Jan-March period is >200
#initiated with QI intervention as of 4/1/2012
# with a successful intervention
# who received a post-initiation viral load test
Site –
Cohort 1 patients
# who are suppressed
GHV –
8 patients
IFH –
47 patients
OD –
9 patients

7. % of unsuppressed patients who received a QI intervention before 4/1/12 and a most recent viral load test since with a suppressed viral load test result

8. QI Interventions Tested
Addressed adherence at medical and Mental Health appointments
one-on-one education
checklist of intervention items
patient questionnaire
case conference
Increased adherence counseling
DOT
Viral Load Visuals
teach back
phone call adherence counseling
increasing clinic attendance (every 4-6 weeks)

9. Shewhart Chart Exercise: Providers agreed to begin to investigate using Shewhart Charts for QIA follow up webinar will be scheduled in July
Clinic Five Clinic Five was well known for using incentives to improve various aspects of care. They had never incentivized adherence to ARV treatment regimen, however, until doing an eHIVQUAL review, and seeing that the viral load suppression rate was less than 40% clinic wide. They came up with a plan, broadly advertising incentives for adherence measured by a suppressed viral load. All patients with a suppressed viral load at their next visit would get a $50.00 gift card from a major credit card company that could be used almost anywhere to buy almost anything. They noticed a major increase in the viral load suppression rate. Unfortunately the gift cards were a one-time donation from the credit card company, so the incentives were not sustainable and neither was the increase in the viral load suppression rate. They believe the data showed that the incentives showed an improvement based on the data. Do you agree? If you agree, please circle the area on the chart where the “special cause” occurred, showing significant improvement, and based on this background information annotate the chart. What is the rule that proves that this change is due to a special cause rather than a common cause?

10. Next Steps
A webinar to further discuss understanding variation over time through the use of the Shewwhart chart will be scheduled
We will share QI project outcomes such as the rate of unsuppressed patients involved in QI interventions across clinics
We will also share with providers viral load suppression rates Sharing aggregate data on PDSA cycles with providers Co-facilitate analysis of data from tests
In addition we will share with providers results from other learning networks involved in QI activities to improve viral load suppression
We will assist providers in negotiating challenges

11. Thanks to Leah Savitsky Andrew Lai Wei Miranda Rosenberg Chris Reisig
Claire McCullough
Johanna Buck
Darryl Ng
Ron Moen
Clemens Steinbock, IA Mentor
Bruce Agins. IA Sponsor

12. And… Beth Bonacci JoAnn Beasley FAYS Team Marc Slifer Janice Bigler
SU Section
Terry Hamilton
Judy Yan
Eunice Casey
HHC Team