Clinical Quality Management (CQM)
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Clinical Quality Management (CQM) in the Ryan White HIV/AIDS Program- Ryan White Part A Administrative Reverse Site Visit Meeting July 30, 2013. CAPT. Tracy Matthews Marlene Matosky U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA)

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Clinical Quality Management (CQM)in the Ryan White HIV/AIDS Program-Ryan White Part A Administrative Reverse Site Visit Meeting July 30, 2013

CAPT. Tracy Matthews

Marlene Matosky

U.S. Department of Health and Human Services (HHS)

Health Resources and Services Administration (HRSA)


Clinical Unit

Learning objectives
Learning Objectives

  • Understand Ryan White legislative requirements for clinical quality management

  • Identify major components of a clinical quality management program

  • Locate clinical quality management resources

Ryan white program 2009 legislation on quality

Assess the extent to which HIV health services are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infections; and

Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services”

Part A: Sec. 2604.(h)(5)

Part B: Sec. 2618.(b)(3)(E)

Part C Sec. 2664.(g)(5)

Part D Sec. 2671.(f)(2)

Ryan White Program 2009 Legislation on Quality

All Ryan White HIV/AIDS Program grantees are required “to establish clinical quality management programs” to:

Program funding opportunity announcement
Program Funding Opportunity Announcement

  • FOA provides minimum expectations for grantees

    • Established and implemented a CQM plan

    • Established processes for ensuring that Primary Medical Care services are provided in accordance with the Department of Health and Human Services (HHS) treatment guidelines and standards of care

    • Incorporated quality-related expectations into Requests for Proposals (RFP) and contracts

  • CQM program information as well as client-level health outcomes data should be used for:

    • Jurisdiction’s planning process

    • Ongoing assessment of progress toward achieving program goals and objectives

    • Examination and refinement of services based on outcomes

Program monitoring expectations
Program Monitoring Expectations

  • Section D: Quality Management

    • Grantee Responsibility

    • Provider/Subgrantee Responsibility

Elements of quality management program
Elements of Quality Management Program

Key elements have been identified as being critical to development & implementation of a CQM program

Key characteristics of a quality management program
Key Characteristics of a Quality Management Program

A systematic process with identified leadership, accountability, and dedicated resources available to the program

2. Use data and measurable outcomes to determine progress toward relevant, evidenced-based benchmarks

3. Focus on linkages, efficiencies and provider, and client expectation in addressing outcome improvement

Key characteristics of a quality management program cont

4. A continuous process that is adaptive to change and that fits within the framework of other programmatic quality assurance and quality improvement activities

5. Ensure that data collected are fed back into the quality improvement process to assure that goals are accomplished and that they are concurrent with improved outcomes

Key Characteristics of a Quality Management Program (cont.)

What is the difference between a clinical quality management program and a quality management plan
What is the Difference Between a Clinical Quality Management Program and a Quality Management Plan?

‘Clinical quality management program’ encompasses all grantee-specific quality activities, including the formal organizational quality infrastructure, performance measurement, and quality improvement related activities

‘Quality management plan’ is a written document that outlines the grantee-wide clinical quality management program, including a clear indication of accountability, performance measurement strategies and goals, and elaboration of processes for ongoing evaluation

Clinical Quality

Management Program

Quality Management Plan




QM Plan



Clinical quality management plan
Clinical Quality Management Plan



Reviewed/updated annually

off process

Shared with stakeholders

Timeline for implementation of goals

Responsible person

Timeline for implementation

  • Quality statement

  • Quality infrastructure

  • Performance measurement

  • Annual quality goals

  • Participation of stakeholders

  • Evaluation

  • Capacity Building

  • Process to update QM Plan

  • Communication

  • Formatting

  • QM Plan implementation

Active roles leaders play in clinical quality management
Active Roles Leaders Play in Clinical Quality Management

Clearly articulated mission & vision statement

Ongoing measurement of performance

Ongoing assessment by leaders

Active coaching by leaders

Engagement of stakeholders
Engagement of Stakeholders

  • Staff, providers, consumers and others should be involved in the CQM program.

    • Engage internal and external stakeholders

    • Communicate information about quality improvement activities

    • Provide opportunities for learning about quality

Tips for performance measurement
Tips for Performance Measurement

Include a portfolio of process and outcome measures

Representative across all funded services

Reporting strategies

Performance measures

2007: Started developing and releasing measures under the guidance of Dr. Cheever

Currently 50+ measures spanning clinical care, oral health care, ADAP, case management, and systems

4 measures received National Quality Forum (NQF) endorsement in February 2013

Performance Measures

Hab guiding principles to measurement
HAB Guiding Principles guidance of Dr. Cheeverto Measurement

  • Measure when it is specific to HIV care

    • Ex: Prescribed ART vs. influenza vaccination

  • Measures align and supported by other agencies in U.S. Department of Health and Human Services (HHS)

  • Paring down the list of measures to those that are most important

  • Clinical measures ability to be used in an electronic health record (EHR)

  • Core set of HHS and HRSA primary care measures

Alignment parsimony
Alignment & Parsimony guidance of Dr. Cheever

  • Working toward a set of National Quality Forum (NQF) endorsed measures

    • Some are HRSA developed/stewarded and others not

  • Working with other HHS partners to identify shared measurement priorities and develop together

    • Reduction in number of HIV measures reported by grantees

Model for improvement
Model for Improvement guidance of Dr. Cheever

The PDSA Cycle

Performance measurement and quality improvement activities balance
Performance Measurement and guidance of Dr. CheeverQuality Improvement Activities Balance

Quality Management

Program Infrastructure

Im guidance of Dr. Cheeverbalance


National quality center

Cooperative Agreement that provides no-cost, technical assistance to all Ryan White funded grantees:

Sharing: Website, various documents/publications, phone consultation, and in+care campaign

Coaching: Intensive on-site consultation

Based on referrals by Project Officers, grantees, or NQC coaches

Technical assistance form available at:

Regional Groups

Training: On-line Tutorials, National TA Conference Calls, Training of Quality Leaders, Training on Coaching Basics, Training of Consumers in Quality, Regional trainings

PENDING: Part A/B organizational assessment

Sign up for the monthly newsletter by sending an email to [email protected]

National Quality Center

Contact information
Contact Information assistance to all Ryan White funded grantees:

Tracy Matthews, MHA, RN


[email protected]

Marlene Matosky, MPH, RN


[email protected]