Section 4: Quality of Care Requirements
The New York State Department of Health AIDS Institute's HIV Quality of Care Program is responsible for the systematic monitoring of the quality of medical care and support services provided to people with HIV infection in New York's health facilities. Created in 1992 and built upon the principles of continuous quality improvement, the program includes measurement of data in key performance areas that have been defined by experts from the provider community.
Paragraph 8 of the Agreement requires facilities providing clinical services under the HIV Primary Care Medicaid Program to fully participate in the HIV Quality of Care Program by meeting all published DOH standards, including:
- Ensuring that HIV care is provided by an HIV specialist or in consultation with an HIV specialist;
- Following AIDS Institute HIV clinical care guidelines;
- Developing and implementing an HIV quality of care program that meets HIV Quality of Care Program standards, and
- Using HIVQUAL software for quality measurement and reporting.
HIV Specialist Policy
Scientific and clinical knowledge about the management of HIV infection and disease continues to evolve at a rapid pace, resulting in frequent changes in state-of-the-art practice. For this reason, the clinical care of persons with HIV/AIDS requires the participation of clinicians with specialized expertise, which is best gained from hands-on experience that includes the direct management of patients on antiretroviral therapy. The following criteria define an HIV Specialist:
- Direct clinical ambulatory care of HIV-infected persons, involving management of antiretroviral therapy, in at least 20 patients during the past year, and
- Ten hours annually of CME including information on the use of antiretroviral therapy in the ambulatory care setting.
For some facilities, particularly in rural or small urban areas where there may be relatively few patients with HIV infection, referral to an HIV Specialist is impractical. In such cases, facilities may develop formal relationships with an HIV Specialist to co-manage patients.
HIV Quality of Care Program Standards
Facilities participating in the HIV Primary Care Medicaid Program must develop and implement a formal quality of care program that is based on quality improvement principles and meets HIV Quality of Care Program standards. The standards provide guidance on quality structure, planning, performance measurement, improvement activities, staff and consumer involvement and evaluation of the quality program.
See www.hivguidelines.org and Sections 6 and 7 for more information on the HIV Quality of Care and Clinical Education Programs and on the AIDS Institute's HIV Specialist Policy.
Use of HIVQUAL Software
Since 1993, the New York State Department of Health AIDS Institute has monitored the quality of HIV primary care at Article 28 licensed facilities, primarily through external chart reviews. In 1995, these medical record reviews were augmented by the introduction of the performance measurement software, HIVQUAL. The software fosters provider capacity to monitor the quality of HIV care and services in a timely manner and to produce frequent reports to track performance over time.
The majority of HIV treatment facilities in New York State currently use HIVQUAL to generate performance data for use in setting goals, identifying areas for improvement and monitoring progress towards improving the quality of HIV care at the facility. Beginning in 2007, all facilities providing clinical care under the HIV Primary Care Medicaid Program must submit annual performance data using HIVQUAL software. Reports for 2006 are due March 31, 2007.
Visit www.hivqual.org to download HIVQUAL3 software and access information on training and technical assistance.