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Standard 2

HIV Quality Management Program

A formal quality of care program that embraces quality improvement (QI) philosophy should be developed and implemented, as part of the HIV service delivery program.

Each HIV quality program should have a comprehensive quality plan that is reviewed and updated annually describing the mission of the quality program, key quality principles and objectives, and the infrastructure of the quality program.

The five components of the HIV quality program are:

A) Infrastructure for HIV Quality Program

The infrastructure of the quality program should be integrated and fully described in the quality plan, with a clear indication of responsibilities and accountability, and elaboration of processes for ongoing evaluation and assessment.

Discussion

The infrastructure should specifically: a) outline quality committees including membership, frequency of meeting and reporting mechanisms; b) specify accountability for all quality improvement activities within the HIV program; c) describe processes to evaluate, assess, and follow-up on HIV quality findings; and d) link the HIV quality program to institution's overall quality program.

The HIV program should detail the roles and responsibilities of leadership and its commitment of resources for the quality program.

Specific programmatic annual goals regarding quality projects and performance measures should be set and shared with program staff. These goals should be formally reviewed and updated by the quality committee at least annually.

B) Staff Involvement in Quality Improvement Activities

All AIDS Center staff, both clinical and support service professionals, should be actively involved in the HIV Quality Program and its quality improvement activities. The participation in the quality program should be part of job expectations. Provisions should be made for ongoing education of staff about quality improvement.

Where Pediatric Maternal HIV Services are provided, appropriate staff must be part of the Quality Programs.

Discussion

The involvement of staff in the quality program should be integrated into job expectations and descriptions. Staff should be able to discuss quality program activities.

The objectives, progress, and results of quality activities should be routinely communicated to staff to increase participation in the HIV quality program.

Members of different professional disciplines and programmatic backgrounds should be included in the quality committee membership.

At a minimum, annual education about quality improvement principles, HIV quality program goals and objectives, and performance measurement indicators and results should be provided to staff.

C) Performance Measurement

Performance measurement should include clearly defined indicators that address clinical, case management and other services as prioritized by the program. A plan for follow-up of results should be outlined.

Discussion

A balanced program of outcome and process measures should be developed and implemented. The quality program should describe its clinical and non-clinical indicators including written definitions, with special emphasis on desired health outcomes, and frequencies of review in the quality plan. Indicators should be updated at least annually and reflect current standards of care.

The HIV program should routinely measure the quality of care with the involvement of staff and review results in quality committees. An action plan for follow-up should include implementation steps and timetable.

Performance data results should be shared with staff, patients, and key stakeholders.

AIDS Centers are expected to submit data via HIVQUAL, based on annual specifications from the AIDOH.

D) Quality Improvement Projects

Quality Improvement activities should be conducted based on performance data results. Specific quality improvement projects should be undertaken which include action steps and a mechanism for integrating change into routine activities. Quality improvement teams should include cross-functional representation.

Discussion

The process of selection and prioritization of quality improvement activities should be clearly outlined and respond to external expectations and internal priorities. Staff should be involved in the selection of quality initiatives.

A process of reviewing results of internal quality initiative and external audits should be integrated into the HIV quality program. The quality committee should oversee and provide feedback to quality improvement projects.

Quality improvement teams with cross-functional representation should be formed to address specific quality improvement opportunities and continue to monitor change.

Results of quality improvement projects should be presented to quality committees, shared among staff, and used for future planning.

E) Participation in Quality Learning Opportunities

AIDS Centers should participate in one or more AI-sponsored Quality Learning opportunities to develop expertise in applying defined, measurable accelerated improvement in the care of individuals living with HIV and contribute to the development of best practices identified through the quality improvement process.

Discussion

The AI provides many Quality Learning opportunities that combine the methods and methodologies of rapid change, peer learning, and individualized consultation. The combined goals of these efforts are to improve the quality of HIV care and services within participating facilities, to achieve measurable desired program outcomes, to strengthen the quality infrastructure, to create a peer learning environment, and to rapidly spread improvements throughout the participating organizations.

F) Consumer Involvement

Consumers should be included in program planning, implementation and quality-related activities.

Discussion

The AIDS Center shall engage consumers in a variety of ways to assure their input about their experiences in the planning and development of services at the AIDS Center. At a minimum, this should include institution of a community advisory board (CAB), participation in quality-related efforts, development of maintenance in care and treatment adherence activities, and the development of harm reduction activities and services.

The Revised Standards