About the Program

The Title I HIV Quality Management Program is managed by the New York State Department of Health AIDS Institute for the HIV Health and Human Services Planning Council of New York City. The Program was created as a result of the reauthorized Ryan White CARE Act, which directs grantees to establish and implement quality management programs. The rationale behind the new legislation is that people living with HIV/AIDS who are receiving treatment require a stable living environment and a variety of specific clinical and social services to permit them to successfully adhere to complex HAART therapies.

The Program is based on the principles of Quality Improvement (QI). Quality Improvement (QI) is based upon specific principles including emphasis on performance data, systems of care instead of individual providers, and improvements made by implementing specific quality projects. The principal goal of the program is to allow providers of HIV-related services in New York City’s five boroughs and the Tri-County region to evaluate and improve the quality of services they offer.

The Title I HIV Quality Management Program consists of a series of interrelated activities, which include the development of performance standards and measurements; data collection, analysis and presentation; and technical assistance using the principles of QI to improve service delivery.

What are the benefits of the Program?

The Title I HIV Quality Management Program allows providers of both clinical and supportive services to:

• Ensure that the highest quality care is provided to patients
• Prevent, identify, and solve problems over time through performance measurement
• Improve systems of delivery of care
• Prepare for accreditation by regulatory facilities

How Is The AIDS Institute Involved?

The New York State Department of Health AIDS Institute (NYSDOH AI) has over 10 years of experience in developing and coordinating a statewide HIV Quality of Care Program to monitor the quality of medical care and services provided to people living with HIV.

In 2001, the Institute was selected by the Title I Planning Council to direct the Program, which includes:

• Indicator development
• Performance measurement
• Data analysis and presentation
• Technical assistance in quality improvement:

How Does The Program Work?

The Title I HIV Quality Management Program consists of a series of interrelated activities.

Indicator Development

The first step is indicator development. At this point, it is necessary to decide which services or aspects of care will be measured. Priorities are identified by the Planning Council and funded providers using the nominal group technique, a formal, participatory decision-making process. Then, the Institute translates these priorities into measurable indicators.

Sampling

Once indicators are chosen, a statistician assists with developing a method for the sampling of medical records. The sampling plan ensures that enough records are reviewed to provide reliable, meaningful data, without requiring the review of more records than necessary.

Data Abstraction

Record abstraction is then carried out by a review agency – usually IPRO or the New York County Health Services Review Organization (NYCHSRO). The agency reviews the individual medical or support service records of people with HIV to measure the selected indicators. Analysis of the data collected from the medical records is carried out by a statistician. All information is held to the highest standards of confidentiality.

Data Dissemination

Data are then disseminated to the grantees so that agencies can evaluate the systems of care at their institution and make needed improvements. Results from similar facilities in the Title I EMA are also provided in a format that permits comparative evaluation and benchmarking analysis.

Quality Improvement

After one year of data has been collected, providers begin to meet with HIV Quality Management Program staff and consultants with expertise in quality improvement to develop projects to improve performance in areas identified by the review process.

Quality Learning Networks

Funded providers in each service area meet approximately four times per year in learning networks led by a quality improvement consultant to exchange experience and learning and to engage in group projects around quality improvement. Learning networks also provide trainings geared towards capacity building. Service providers can also request individual consultation towards capacity building for quality improvement.

Subsequent reviews provide measurable feedback to facilities regarding changes in their performance and the impact of their quality improvement initiatives.

Service Areas

The New York City Title I EMA utilizes Ryan White Title I funds to provide a wide array of services for people living with HIV/AIDS. The following are some of the service areas for which the Title I HIV Quality Management program has implemented quality activities. Specific activities include indicator development, performance measurement, and facilitation of quality learning networks.

Treatment Adherence – Funded agencies provide education, support and counseling to promote access to and adherence with prescribed treatments in order to improve the quality and length of life for HIV/AIDS patients. Counselors assist clients with making informed choices about treatment options and in addressing the many issues related to adhering to treatments.

Mental Health – Funded agencies provide licensed outpatient mental health services for people living with HIV/AIDS. Services include psychological and psychiatric treatment and individual and group counseling.

Case Management – Funded agencies provide client-centered programs that link individuals with primary medical care and health-related support services to ensure timely, coordinated access to the full continuum of care. Case management professionals assist clients access various services including medical care, housing, food, substance abuse treatment, home care and mental health services.

HIV Home Care – Funded agencies provide comprehensive, coordinated home-based health care, support and service coordination that addresses the full range of client needs. Services provided include psychosocial support, bereavement counseling and pastoral care to family members and caregivers as well as respite for caregivers, including child care during appointments and hospitalizations and assistance with household chores.

TB DOT/DOPT (Directly observed therapy/ Directly observed preventive therapy) -
Funded agencies develop programs designed to improve clinical outcomes of people infected with tuberculosis (“TB”) or co-infected with HIV and TB in successfully completing TB prophylaxis or treatment. Services provided include direct observation of patient ingestion of medication and other supportive services designed to support client’s involvement in their health care.

Oral Health – Funded agencies provide comprehensive dental care, including diagnostic, prophylactic and therapeutic services as a component of HIV healthcare in a community-based setting. Patient and community education about the importance and availability of dental services for people with HIV is provided

Food and Nutrition – Funded agencies provide home delivered meals, congregate meals and pantry bags to people living with HIV/AIDS, along with nutritional assessment and counseling.

Housing – Funded agencies provide assistance in locating, obtaining and/or maintaining suitable emergency, transitional or on-going shelter.

For more information about the Title I HIV Quality Management Program please contact Frank Laufer at fnl01@health.state.ny.us or by phone at 212-417-4558 or Mindy Nass at mdn01@health.state.ny.us or by phone at 212-417-4560.