October 6, 2017
The New York State HIV Quality of Care Program, overseen by the Office of the Medical Director, is committed to advancing the quality of HIV clinical care and supportive services delivered to people living with HIV and to building capacity for quality management in HIV programs throughout New York State. These goals are consistent with the mission of the AIDS Institute and the goals of the Governor’s Initiative to End the Epidemic (EtE) by 2020 to accelerate measurable and continuous progress toward effective and consumer-centered services and improved patient outcomes.
The following New York State HIV Quality of Care Program Standards are applicable to HIV programs that receive state funding or support in New York State, regardless of funding streams, caseload, or service delivery models.
The HIV quality management program is actively supported and formally guided by clinical leaders for medical programs, or by senior program leaders for nonmedical service programs, who provide institutional commitment and allocate appropriate resources to ensure sustainable implementation of improvement activities. The HIV quality management program is effectively linked with the organization-wide quality management program, as evidenced by the routine reporting of improvement efforts and performance measurement data.
HIV program staff: Program staff are aware of the quality management infrastructure, understand their roles in improvement activities, and actively participate in agency-wide quality management program activities.
HIV quality management committee: The HIV quality management committee is accountable for HIV-specific improvement activities, development of annual quality improvement goals, prioritization of key quality indicators for review, routine evaluation of the HIV quality management program, and sharing of HIV performance data with staff and stakeholders, including consumers. The committee membership includes staff from all key medical and non-medical services. Consumer representatives are included who provide input to ensure that services effectively meet or exceed patient needs and expectations. The committee meets at least once every other month.
Quality management plan: Each HIV quality management program has a written quality management plan that is reviewed and updated annually by the HIV quality management committee. The plan is shared with staff and consumers to gather input and to promote involvement in the quality management program and its activities. The plan includes the following elements:
- Quality statement describing the overall mission of the HIV quality management program;
- Staffing plan describing roles and responsibilities pertaining to the quality management program including the quality committee, its membership, and leadership;
- Performance measurement activities describing indicators and data collection methodologies;
- Annual improvement goals based on identified gaps in specified performance data, as well as internal program priorities and statewide public health objectives;
- Processes for training and engagement of staff, consumers, and stakeholders; and
- Procedure(s) for routine evaluation of the quality management program.
The quality management plan includes a formal work plan that identifies implementation responsibilities and a timetable for their completion. The work plan is reviewed routinely at quality management committee meetings and is in the formal evaluation of the HIV program to monitor whether it is being implemented as planned and whether goals are achieved.
Performance indicators: Performance indicators guide the development and implementation of improvement activities. Indicators are chosen based on identified gaps in performance, internal HIV program priorities, and external expectations. At a minimum, indicators measure key health outcomes, such as viral suppression. The quality management plan describes these performance indicators, including their definitions, sources of data, desired health outcomes, and frequency of data collection. Indicator definitions are updated at least annually to reflect current standards of care and practices.
Performance reviews: HIV program staff conduct and analyze the performance of core HIV services at least quarterly, with any more frequent measurements conducted based on identified needs for improvement. Additional measurement is conducted to fulfill reporting expectations of the New York State HIV Quality of Care Program. All Ryan White HIV/AIDS Program Part B-funded subrecipients are expected to submit performance measurement data for specified quality indicators to the AIDS Institute on a quarterly basis.
The HIV program generates and reviews newly diagnosed and established patient HIV treatment cascade data at least annually as delineated in HIV Organizational Treatment Cascades: Guidance for Construction. Programs are expected to develop, measure, and revise process changes aimed at diminishing gaps identified by the cascades in linkage, engagement, treatment, and viral suppression outcomes to improve patient health and contribute to statewide goals aligned with the Governor’s EtE Initiative.
Data analysis and follow-up: Performance data results are reviewed during quality management committee meetings to guide improvement activities. Data are disaggregated by key patient characteristics to identify potential disparities in HIV care and services, including, at a minimum, age, gender, exposure category, and race/ethnicity. An action plan to address performance gaps includes a description of implementation steps, specific responsibilities, and a timeframe for completion of activities. Performance data results are shared with staff, consumers, and key stakeholders.
Information system: The HIV program has an information system in place for tracking all people living with HIV – even if they are not receiving HIV care from the organization – and for monitoring patient care across the entire organization. The information system integrates electronic patient records, prescription, and laboratory records. The program’s information system produces meaningful performance data reports that include patient-specific and aggregate data on key quality of care indicators, such as viral suppression. The system is accessible to all relevant staff.
Data across information systems are coordinated. The program is encouraged to use data from Regional Health Information Organizations (RHIOs) to augment the analysis of information available internally to promote coordination of care and ascertain care status
The HIV quality management program continuously strives to eliminate gaps in quality of care outcomes that are identified and prioritized by the HIV quality management committee, based on organizational treatment cascade findings, other performance data, and consumer and staff input, as well as external expectations.
Improvement teams with cross-functional representation, including consumers, are formed to address specific gaps in care; drill down data; investigate and improve current processes; and monitor changes, adjusting processes accordingly. Results of continuous improvement work are presented to the HIV quality management committee, shared among staff and consumers, and are used to spur further improvements and to direct future planning.
Staff members representing all roles and disciplines, including medical providers, are members of the HIV quality management committee and improvement teams. Staff are required to participate in quality management activities; this is delineated in job descriptions.
Staff are designated to participate in AIDS Institute-supported capacity building activities, such as NYLinks Regional Groups and QI Learning Networks, which improve quality of care outcomes through peer learning, accelerate improvement project implementation, and contribute to the statewide initiative to End the Epidemic. Staff are informed of the objectives, progress, and results of improvement activities, in order to increase awareness and participation in the HIV quality management program.
Staff receive quality improvement training at least once a year and are provided with updates of QI activities, at a minimum, on a quarterly basis.
Staff satisfaction is assessed at least annually and results are shared with staff and used for improvement.
Consumers are routinely asked to provide their input and feedback in the selection of improvement priorities. Consumers participate in the HIV quality management program activities, as members of the quality management committee and participants in improvement teams. Consumers also provide feedback on the HIV quality management program by responding to formal solicitations for public comment and by participating in an organization’s consumer advisory board.
Consumers are offered the opportunity to participate in trainings in quality improvement and are provided with an organization’s performance data results and findings.
Consumer experience is assessed at least annually and findings of the assessment are formally integrated into improvement activities and communicated back to staff and consumers, as specified in the guidance issued by the AIDS Institute.