Newly Funded Ryan White Part C and D Quality Improvement Initiative

Concept Paper

October26, 2012

Contents

A) Background of the Newly Funded Ryan White Part C and D Initiative...... 1

B) Purpose of the Newly Funded Ryan White Part C and D Initiative...... 2

C) Infrastructure of the Newly Funded Ryan White Part C and D Initiative...... 3

D) NQC Offeringsto Newly Funded Ryan White Part C and D Grantees...... 3

E) Evaluation of NQC Activities for Newly Funded Ryan White Part C and D Grantees...6

F) Sustainability of Ryan White Part C and D QIActivities Beyond June 2013...... 7

A) Background of the Newly Funded Ryan White Part C and D Initiative

On August 1, 2012the HIV/AIDS Bureau announced the newly funded Part C and D grantees. At this time, the entire Ryan White HIV/AIDS Program (RWP) Part D was re-configured for FY 2012 in order to respond to changing HIV epidemiology and the National HIV/AIDS Strategy. The goal of RWP Part D grantees is to provide comprehensive health care services for the women, infants, children and youth populations in areas of greatest need for services. Part D granteesare expected to provide: HIV primary care; specialty medical care; and support services to the clients they serve. In addition, new Part C grantees were funded in FY2012. Part C programs focus more broadly on the direct medical care of all people with HIV. Of the 114 RWP Part D grantees currently funded, 36 (32%) were newly funded in the current competitive application process and 14 (12%) are not connected with currently funded Part C grantees. The newly funded RWP Part C programs are all new to the RWP system; however two of the 14 new grantees overlap with newly funded Part D grantees in their agencies.

Since 2000, significant additional legislative requirements of the reauthorized legislation directed Ryan White HIV/AIDS Program-funded grantees to develop, implement, and monitor clinical quality management programs. The HIV/AIDS Bureau (HAB) has outlined clinical quality management expectations across the entire Ryan White funding continuum, including all newly funded Part C and D grantees. Expectations include utilizing HAB developed performance measures in quality improvement activities to monitor and evaluate clinical outcomes, and demonstrate consumer participation in improvement activities. The purpose of the Initiative described in this concept paper is to strengthen clinical quality management activities of the new Part C and D funded programs and to improve the systems of medical care for those served by these grantees.

In 2008, the National Quality Center (NQC) completed a study of individuals across all Ryan White grantees that have received NQC technical assistance(TA) services. Among these findings, NQC learned that only 64% of all RWP Part D grantees participated in NQC/HIVQUAL activities at that time, the lowest percentage among the RWP funding streams. In conjunction with HAB, NQC developed new Part-D specific interventions and services designed to strengthen Part D-specific quality improvement activities. In 2011, a subsequent studyby NQC found an increased uptake of Part D grantees participating in NQC/HIVQUAL activities (from 64% in 2008 to 94% in 2011). The study also reported a marked increase of Part D staff representatives participating in NQC/HIVQUAL activities from 243 individualsin 2008 to 945 individuals in 2010. In a comparison of Part Dquality improvement (QI) competencies, 40% of Part D representatives identified themselves as QI beginners in 2009 versus 19% in 2011 (n=263).A detailed listing of Part D grantees engaged in NQC activities as presented in the 2008 and 2011 NQC report is available upon request. Part C programs have traditionally had a high level of participation in NQC activities, but the 14 newly funded Part C grantees are included in this Initiative to increase their engagementin learning QI skills.

In August 2012, the New York State Department of Health was re-funded to maintain the NationalQualityCenter and to provide the RWPgrantee community with TA and coaching around quality management and improvement. This funding opportunity merged the previous NQC and HIVQUAL activities under the overall umbrella of the NQC. As part of this grant, NQC received specific funding(through the end of June 2013) dedicated to work with Part D grantees, enhance their clinical quality management programs, and ultimately improve HIV care. The HIV/AIDS Bureau later added the newly funded Part C grantees to the initial charge.

B) Purpose of the Newly Funded Ryan White Part C and D Initiative

The goal of this Initiative is to support/coach newly funded Part C and D grantees to improve HIV care utilizing successful improvement methodologies. NQC, in conjunction with theHAB Division of Community HIV/AIDS Programs (DCHAP), has identified the following TA objectives to be completed by June 2013:

  • to identify specific TA needs of newly funded Part C and D grantees through a formal needs assessment process to establish sustainable clinical quality management programs that improve patient health outcomes
  • to describe current agency-specific quality improvement interventions and findings for newly funded Part C and D grantees, including recent organizational assessment (OA) findings, participation in ongoing communities of learning, and performance rates of key quality measures
  • to promote the rangeof TA offerings available to all newly funded Part C and D grantees with a focus on peer learning-including routine webinars andopportunities to share best practices-to promote existing quality improvement resources
  • to engage all newly funded Part C and D grantees specifically in the NQC-sponsored in+care Campaign and provide support to those grantees that are active participants in this national quality improvement Initiative through the formation of a newly funded Part C and D discussion group
  • to target Part D grantees identified as high need by DCHAP staff for intensive TAby experienced quality improvement coaches based on information gathered fromthe inventory of past Part D quality improvement interventions and findings
  • tooutline a plan to sustain the quality improvement gains beyond June 2013

C) Infrastructure of the Newly Funded Ryan White Part C and D Initiative

NQC proposes to establish a Newly Funded Part C and D Planning Committee to form the backbone of the Initiative infrastructure and to provide administrative oversight. This Planning Committee will include8 members:

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  • 3 NQC staff members
  • Clemens Steinböck
  • Michael Hager
  • Darryl Ng
  • 2 HAB Clinical Team members
  • TBD – HRSA
  • 3 HAB DCHAP Team members
  • TBD – HRSA

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Through the end of 2012, the Planning Committee will convene via conference call every two weeks to discuss NQC progress in implementing the work plan and meeting goals and objectives. Moving forward in 2013, NQC is confident that the frequency of Planning Committee calls can be scaled back to monthly as NQC offerings fornewly funded Part C and D are being implemented. By June 2013, NQC will draft a sustainability plan and review it with the Planning Committee. As needed, NQC will convene focus groups of newly funded Part C and D grantee representatives, to solicit ideas and suggestions for input from programs served through this Initiative.

Potential topics for initial discussion among members of the newly funded Part C and D Planning Group include how to: best engage all newly funded Part C and D grantees in this Initiative; outline expectations for participation; develop the newly funded Part C and D needs assessment; and review past TA results and findings.

NQC staff will report on activity and fiscal progress within Trimester reports that are forwarded to the HAB Clinical Team every four months. At the end of the Initiative, in 2013, NQC will draft a summary report of this Initiative, including its planning, implementation and evaluation to help in establishing future QI initiatives.

D) NQC Offerings toNewly Funded Ryan White Part C and D Grantees

a) Part D Needs Assessment

NQC will initiate a specific Needs Assessment for newly funded Part C and D grantees in December2012 in addition to a general Needs Assessment of all Ryan White grantees.The Needs Assessment specific to newly funded Part C and D grantees will consist of an online survey that will be distributed to all newly funded Part C and D grantees. The survey will be constructed with input from the newly funded Part C and D Planning Committee and will identify TA needs and the most effective modalities for providing support. Key findings from the survey will be shared with planning committee in a summary report. Planning committee will advise NQC on designing specific programming based on needs identified in the survey. NQC will move forward with the agreed upon programming..

b) Inventory of Past QI Interventions and Findingsamong Newly Funded Part C and D Grantees

NQC will construct a QI-focused inventory report of all newly funded Part C and D grantee interactions with NQC/HIVQUAL over the years. For each newly funded Part C or D grantee, this inventory will include:

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  • Organizational Assessment Findings
  • HIVQUAL Regional Group Participation
  • NQC TA Activities
  • in+care Campaign Participation and Data
  • Cross-Parts Collaborative Participation
  • TOT/TQL/TCB Participation

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  • Results from Recent QI Projects

ThisQI inventory report will also include a summary of these activities. Findings from recent results that have been compiled by NQC or HIVQUAL will be summarized and included for each Part D grantee.

c) Development of a QI Toolkit

In order to share existing QI resources, NQC will develop a Part C and D QI Toolkit specific to newly funded Part C and D needs. This Toolkit will include:

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  • Detailed grantee expectations and milestones for participating in this newly Funded Part C and D Initiative
  • QI resource library for newly funded Part C and Dgrantees based on existing NQC QI publications, online resources, etc.
  • Background information specifically on quality improvement project design and implementation.
  • Part C and Part D OA Forms
  • Links to the Quality Academy tutorials,including a prioritized viewing list
  • Instructions to access the privatenewly Funded Part C and D Community Project Space
  • Instructions for in+care Campaign enrollment and participation
  • Announcements of upcoming activities for newly funded Part C and D grantees
  • TA Request Forms for on/off-site TA

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NQC will house the Part C and D QI Toolkit on a dedicated page on its website at NationalQualityCenter.org. One of the main purposes of the Toolkit will be to layout for newly funded Part C and D grantees the ways they can participate in this Initiative. Milestones and suggested reading will be included in the How-to-Guide portion of the QI Toolkit. The QI resource library in the Toolkit will be based on existing NQC publications and other materials-the Planning Committee will review thesefor appropriateness beforehand. The Toolkit will provide direct links to the QualityAcademyand prioritize relevant tutorials clearly. A link to a private, dedicatedPart C and D Community Bulletin Board in the NQC Project Space will also be introduced in the Toolkit. Past key improvement strategies from newly funded Part C and D participants in the in+care Campaign, and Part C and D Needs Assessment summary findings will also be located within the Toolkit. Finally important forms and templates will also reside in the Toolkit for quick reference by newly funded Part C and D grantees. The NQC will review and update all resources in the Toolkit as needed. If grantees request more information or QI materials than those provided in the Toolkit, NQC will immediately disseminate further resources via email or mail.

d) Newly Funded Ryan White Part C and D Peer Learning Opportunities

NQC will provide newly funded Part C and D grantees with peer learning opportunities through thisNewly Funded Part C and D Initiative. In addition to the general NQC National TA calls, NQC will establish a set of quarterlyPart D specific to the newly funded Part C and D grantees that will draw on results of specific needs assessment findings and where possible, will relate back to in+care Campaign and HIVQUAL Regional Group work. NQC will develop the schedule and topic list for newly funded Part C and D TA calls with input and feedback from the planning committee and data gathered through the needs assessment. Similar to other NQC TA calls, the newly funded Part C and D-specific TA calls will involve webinar formats to enhance interaction and sharing among participants. A primary goal of the TA calls for newly funded Part C and D grantees is to showcase quality champions among Part C and D grantees and to highlight promising strategies and opportunities for improvement and for collaboration.

NQC will also be presenting the quality management TA opportunities at a DCHAP meeting for newly funded Part C and D granteesduring the 2012 All Grantee Meeting in Washington, DC in conjunction with DCHAP staff. This face-to-face opportunity builds on the momentum from the All Grantee Meeting and takes advantage of the presence of all the grantees. NQC is considering convening additional, regional face-to-face workshops for newly funded Part C and D grantees to gather together depending on the results of the 2012 needs assessment and their geographic distribution.

e) Communities of Learning

NQC facilitates a number of communities of learning into which newly funded Part C and D grantees will be specially integrated. First, NQC will be working with all Part C and D grantees to ensure they are involved in the in+care Campaign. These Part C and D grantees will receive a special orientation to the Campaign through an upcoming HAB call for newly funded Part C and D grantees to reinforce the HAB expectation that all Part C and D grantees participate. A Part C and D groupwill be created in the Campaign database to track newly funded Part C and D grantee performance overall. Webinar programs will periodically be held to review data submitted by participating Part C and D grantees and to discuss potential strategies of interest for improving patient retention in care in their settings based on periodic discussions with TWG that will be nested in the existing enhanced data report writing process.

Second, NQC will work with existing HIVQUAL Regional Group coaches to integratethese Part C and D grantees into nearby groups, with the aim of making their entry into the groupsas smooth as possible. Special invitation letters will be sent to Part C and D grantees operating in areas where HIVQUAL Regional Groups are currently meeting. NQC will discuss progress in building membership of newly funded Part C and D grantees in these groups during Planning Committee calls.

f) On-Site Technical Assistance to Selected Newly Funded Ryan White Part C and Grantees

NQC will identify experienced QI coaches who are knowledgeable of the services provided and populations served by Part C and D programs. Once NQC completes its needs assessment specific to the newly funded Part C and D grantees and the inventory report of previous QI activities, the Part C and D Planning Committee will begin to triage need for on-site TA. Specifically, the Committee will consider all newly funded Part C and D grantees that are not associated with existing Part C or D programs appropriate for on-site TA. Additional sites will be targeted for on-site TA based on needs assessment findings at the discretion of the Planning Committee. Part C and D grantees will also be able to request on-site TA through a link on the Part C and D Initiative page of the NQC website during the lifetime of this Initiative. Sites may request TA using the standard NQC TA Request Form and the Planning Committee will review each request for appropriateness.

Building on the traditional NQC TA model, all sites selected to receive on-site TA will be assigned a dedicated QI coach. All TA requests will be triaged within 5 days. NQC will then carry out an initial TA call with targeted recipients. The coaches will travel to sites to perform a face-to-face OA and to discuss TA objectives and to set expectations for the TA experience. In addition to monthly coaching calls, coaches will provide progress reports on meeting the TA objectives and outcomes via the Project Management Database. Each coach is expected to provide progress updates at least once per month. At the close of on-site TA activities, the QI coach will generate a Final TA Report via the Project Management Database. NQC staff will manage the coaches to assure monthly progress updates are provided, review progress updates to follow-up with Committee as needed; and compile the final TA reports at the close of the Initiative (June 2013). Grantees that already have existing relationships with NQC coaches will maintain those existing coaching relationships.The coaches with existing Part C and D grantees in their portfolio will also provide monthly progress updates and will include these sites in the Final TA Report.

E) Evaluation of NQC Activities for Newly Funded Ryan White Part C and D Grantees

NQC will work with JSI on evaluating the impact of itsTA activities targeted to newly funded Part C and D grantees through this Initiative, which will be harmonized with the overall NQC evaluation framework. NQC, JSI and HAB each recognize the importance of establishing data systems up front for the capture of evaluation information specific to this Initiative. The evaluation will involve a mixed-methods approach incorporating: