Understanding and Using Your HIVQUAL Data

1. Understanding and Using Your HIVQUAL Data March, 2011 HIVQUAL Workshop

2. Agenda The National AIDS Strategy And the HIVQUAL Process Generating eHIVQUAL Data Validation Reports Dashboard and Sharing Data to gain buy in for Quality Analyzing Aggregate Data Report Large Group Discussion (9:15 – 9:30 AM) (9:30 – 9:40 AM) (9:40 – 10:00 AM) (10:00 – 10:30 AM)

3. Agenda Continued Brainstorming Improvement Small Group Exercise Generating Data Reports by Specific Demographic Points Analyzing Data Reports by Specific Demographic Points Small Group Exercise Evaluation Finish (10:30 – 11:00 AM) (11:00 – 11:30 AM) (11:30 – 11:50 AM) (11:50 AM – 12:00 PM) (12:00 PM)

4. How can NYSDOH AI Quality of Care Program Support the National HIV/AIDS Strategy? Establish a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV.  Increasing access to care and optimizing health outcomes for people living with HIV; and, Reducing HIV-related health disparities.

5. National HIV/AIDS Strategy By 2015: Increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20 percent. Increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20 percent. Increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20 percent

6. National HIV/AIDS Strategy Increase the proportion of Ryan White HIV/AIDS Program clients who are in continuous care (at least 2 visits for routine HIV medical care in 12 months) from 73 percent to 80 percent. Increase the percentage of Ryan White HIV/AIDS Program clients with permanent housing from 82 percent to 86 percent (from 434,000 to 455,800 people). This serves as a measurable proxy of our efforts to expand access to HUD and other housing supports to all needy people living with HIV.  Increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65 percent to 85 percent.

7. National Strategy contd. 1.1 Ensure that high-risk groups have access to regular viral load and CD4 tests: All persons living with HIV should have access to tests that track their health, but more must be done to make sure that these tests are available to African Americans, Latinos, and gay and bisexual men Measure and utilize community viral load: Ensure that all high prevalence localities are able to collect data necessary to calculate community viral load, measure the viral load in specific communities, and reduce viral load in those communities where HIV incidence

8. How can NYSDOH AI Quality of Care Program Support the National AIDS Strategy? Optimal clinical care should include a range of integrated clinical and preventive services to reduce HIV-related morbidity and mortality. Patient-centered care–defined by the Institute of Medicine as health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences–should be the standard.

9. Actions are based upon accurate and measured data.

10. HIVQUAL Model - Overview Infrastructure

11. HIVQUAL Model - Overview • Goal to assist health care facilities in developing a quality infrastructure that supports ongoing quality improvement activities. • Emphasis on sustainability by focusing on the structural programmatic and implementation level. • Practical guide for all HIV programs, regardless of their service delivery model, patient caseload, or site location. • Developed by the New York State Department of Health AIDS Institute in collaboration with HIVQUAL consultants.

12. HIVQUAL Model – Program Cycle • Step I: Develop and Plan an HIV Quality Improvement Program • Form a quality improvement committee • Develop a quality improvement management plan • Strategize to implement the quality plan, develop a workplan • Step II: Facilitate Implementation of HIV Quality Improvement Program • Establish performance measurement systems • Establish improvement project teams • Build support for the HIV quality program • Step III: Evaluate HIV Quality Improvement Program • Evaluate HIV quality program effectiveness and facilitate future planning • Evaluate project team performance • Strategize to sustain HIV quality program and its activities

13. HIVQUAL Model HIV Quality Program Develop and Plan a Quality Improvement Program Evaluate HIV Quality Improvement Program Facilitate Implementation of HIV Quality Program Quality Project Step 1: Review, Collect and Analyze Data Step 2: Develop a Project Team Workplan Step 6: Systematize Change Step 3: Project Team Investigates the Process Step 5: Project Team Evaluates Result(s) with Key Stakeholders Step 4: Project Team Plans and Tests Change(s)

14. Act Plan Study Do HIVQUAL Model HIV Quality Program Develop and Plan a Quality Improvement Program Evaluate HIV Quality Improvement Program Facilitate Implementation of HIV Quality Program Quality Project Step 1: Review, Collect and Analyze Data Step 2: Develop a Project Team Workplan Step 6: Systematize Change Step 3: Project Team Investigates the Process Step 5: Project Team Evaluates Result(s) with Key Stakeholders Step 4: Project Team Plans and Tests Change(s) 14

15. Questions for Data Follow-up • What are the results for key indicators? • What are the major findings based on the generated data reports and your data analysis? • What is the frequency of patients / programs not getting care? • What is the impact of not getting the care? • How does the performance compare with benchmark data? • What is the feasibility of improving the care?

16. Key Questions for Data Follow Up (Cont’d) • How can you best share the data results with your key stakeholders (Part A/B QI committees, HIV providers, consumers, etc.)? • How do you generate ownership among providers and consumers? • How will you assist in initiating/implementing QI projects to address the data findings? Who will be responsible and what are the next steps?

17. The PDSA cycle for learning and improvement Act Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) What changes are to be made? Next cycle? Study Do • Complete the • analysis of the data • Compare data to • predictions • Summarize what • was learned Carry out the plan Document problems and unexpected observations Begin analysis of the data

18. HIVQUAL Model – Project Cycle • Step 1: Review, Collect and Analyze Baseline Data • Step 2: Develop a Project Team Workplan • Step 3: Investigate the Process • Step 4. Plan and Test Changes – PDSA Cycles • Step 5: Evaluate Results with Key Stakeholders • Step 6: Systematize Change

19. 11:15 eHIVQUAL Data and Reports • Generating eHIVQUAL Data reports: • Data Verification Report • Dashboard • Aggregated Data Management Reports • Individual Quality Indicator Reports • Quality Indicator results by race, gender, ethnicity, age

20. Exporting all eHIVQUAL Reports • You can export your reports directly to your computer in various formats for printing, etc. • To export as an Excel*: • Step 1: Once your report is loaded, select “Excel” from the dropdown list labeled “Select a format” in the top left-hand corner. • Once you have made your selection, click on “Export”. • Open and save the file to your computer as with any other download. * Repeat for file types PDF, CSV, etc.

21. Data Validation Report • Step 1: When logged into eHIVQUAL, click on the “Report List” tab (top left-hand corner). • Step 2: Under “Select a report” click on “Detailed Data Validation”. • Step 3: Under “Review Period” select the dates of the review (1/1/09-12/31/09). • Step 4: Click on “Report”, on the bottom left-hand corner.

22. Data Validation Report Example

23. Dashboard • Step 1: When logged into eHIVQUAL, click on the “Report List” tab (top left-hand corner). • Step 2: Under “Select a report” click on “HIVQUAL Dashboard”. • Step 3: Under “Review Period” select the dates of the review (1/1/09-12/31/09). • Step 4: Click on “Report”, on the bottom left-hand corner.

24. Dashboard

25. Elements of the Dashboard Reports • After generating your Dashboard, click on “Visit Distribution” below the corresponding image*: *Repeat for “CD4/Viral Load Monitoring”, “Diabetes Management”, “Viral Load Suppression” and “Mental Health Components”. Click here

26. Dashboard – Visit Distribution

27. Elements of the Dashboard Reports cont. • To generate the TB report within “Screening Indicators”, click on the top, red bar on the graph. Screening Indicators (within review period) *Repeat for “Substance use”, “Tobacco”, “Pap test”, “ Dental”, “Syphilis” and “Mental Health”. Click here

28. Dashboard – TB

29. Aggregate Management Reports • Step 1: When logged into eHIVQUAL, click on the “Report List” tab (top left-hand corner). • Step 2: Under “Select a report” click on “Aggregated Management Report 1”.* • Step 3: Under “Review Period” select the dates of the review (1/1/09-12/31/09). • Step 4: Click on “Report”. * Repeat for Aggregate Management Reports 2 – 5

30. Aggregate Management Report # 1

31. Aggregate Management Report # 2

32. Aggregate Management Report # 3

33. Aggregate Management Report # 4

34. Aggregate Management Report # 5

35. Using Reports for QI • Individually review data results from Aggregate Management Report 3. • What areas scored well across all facilities? • What areas scored well across some facilities? • In what areas did all facilities receive low scores? • What does this suggest?

36. Scenario • You are the HIV QM of an HIV Primary Care Provider with 3 distinct clinics where HIV Service is provided. After completing your eHIVQUAL Review, you generate the Aggregated Management Report 3. • What ideas for improvement activities does the report suggest? • Small Group Work: Brainstorm possible QI activities. How would you measure the success rate? • Report back to larger group.

37. Generating reports by demographic points • Step 1: After clicking on “Report List”, select the report type, review period, and sites (if applicable). • Step 2: Make selections for further demographics. • For CD4/VL, use the drop down list to select either “ALL”, “Lowest CD4 <=” or “Highest CD4 >=”. Type the value of your desired cutoff. • Example: “Lowest CD4 <=”, 50

38. Generating reports by demographic points cont. • Step 2 cont: Make selections for further demographics. • For Gender, select either “ALL”, “Female”, “Male” or “Transgender”. • For Age, select either “ALL”, “Over” or “Under”. Type the value of your desired cutoff. • Example: “Under”, 35 • For ARV Therapy, select either “All Included” or “On ARV Only”.

39. Generating reports by demographic points cont. • Step 2 cont: Make selections for further demographics. • To filter by Race, State, Risk, Type (Facility) and/or Title (Ryan White) use the dropdown list labeled “1:”. • Example: Select Race. Then select “Selected”. Select “White non-Hispanic”, “Black non-Hispanic”, etc. NOTE: You can simultaneously filter by two of the following: Race, State, Risk, Type (of facility) or Title (Ryan White). Select the second demographic in dropdown list “2:”

40. Viral Load Suppression Dashboard Report – All patients

41. Viral Load Suppression Dashboard Report – Filtered by Risk - IDU Highest VL during review period

42. Viral Load Suppression Dashboard Report – Filtered by Risk/MSM and Race/Hispanic & Black non-Hispanic Highest VL during review period

43. Viral Load Suppression Report Use for QI • After reviewing these reports, what activities for improving the quality of care do you suggest? • Small Group Work: Brainstorm possible QI activities based on data results. • Report back to larger group.

44. Contact information: • If you have any questions or would like to request TA/Coaching at Your site on using data for QI, please contact: • Dan Belanger (212) 517-5131 drb08@health.state.ny.us

45. Special Thanks to: • Bruce Agins, MD MPH • Christopher Wells • Amanda Bowes