Quality of Care Programs

New York State Quality of Care Program

The AIDS Institute is committed to promoting, monitoring, and supporting the quality of HIV clinical services for people with HIV in New York State (NYS).  The Office of the Medical Director (OMD) has provided important leadership in improving HIV care among providers within NYS and nationally.  Integrating performance data to identify and monitor quality of care indicators, establishing effective quality management programs, and engaging consumers in substantive discussion and consensus building have served as a template for programs that have benefitted countless people with HIV worldwide.

The NYS Quality of Care (QOC) Program is committed to ensuring equitable access to HIV care that promotes the health and wellbeing of all people living with HIV (PLWH) in NYS. The QOC Program collects data on the performance of HIV providers, uses these data to identify areas for improvement, and fosters improvement both by supporting improvement activities and by building capacity for quality management.

OMD coordinates the participation of several groups of stakeholders to accomplish these tasks including (1) the HIV QOC Workgroup, an internal workgroup which coordinates the various AIDS Institute quality programs and activities; (2) the HIV QOC Clinical Advisory Committee (QAC), composed of expert HIV providers who advise on the development, implementation, and refinement of the QOC Program; (3) the Joint Consumer Advisory Committee (CAC) and Young Adult Consumer Advisory Committee (YACAC), composed of the individuals representing the diverse communities and regions affected by the HIV epidemic in NYS; and (4) the HIV Clinical Guidelines Program, responsible for clinical guidelines development.

The following quality improvement initiatives are integrated into the QOC Program and are being implemented or continued statewide in 2020:

  • Organizational HIV Treatment Cascade: With the goal of increasing the proportion of PLWH who achieve durable viral suppression, the QOC program has asked clinical HIV providers across NYS to submit organizational treatment cascade data, which identify the proportion of PLWH at each clinic at each stage of the care continuum, from diagnosis through viral suppression. Using an excel template created by the QOC, providers can generate various data visuals to assist in their analysis of outcomes and to develop improvement activities.  These organizational treatment cascade data allow providers to clearly identify gaps along the pathway from linkage and engagement in care to viral suppression and to develop and guide improvement activities that aim to address those gaps. The data, analysis and improvement plan are all submitted using this same template to the QOC program via the Health Commerce System.
  • The program will provide cascade review data for the AIDS Institute’s Health Equity Program and will encourage HIV providers to use their cascade review data to mitigate disparities in health outcomes and increase data driven health equity.
  • In addition to the organizational treatment cascades, additional topic-specific reviews are conducted annually in accordance with identified priority areas.  Areas being considered by the QAC and CAC are HIV and aging, HIV and long-term survivors, Hepatitis C co-infection, and sexual health.
  • The QOC focuses upon stigma reduction and resiliency building.  The program works with the Stigma and Resiliency (STAR) Coalition which includes Columbia University and New York City Department of Health and Mental Hygiene (NYCDOHMH), in identifying effective stigma reduction activities through interviewing HIV care providers.  The QOC Program will support the QAC and CAC in creating a catalogue of stigma reduction activities to be shared with providers throughout the state.
  • A Quality Improvement (QI) curriculum is being developed by the program for training of QI.
  • QOC Program collaborates with clinical and supportive service providers, particularly all Part B recipients, to provide QI coaching and training and to monitor the quality of care.
  • The QOC Program provides QI training for staff of the AIDS Institute.
  • The QOC Program will collaborate with CEI in focusing on viral load suppression (VLS) low performers.
  • The QOC Program will continue a collaboration with NYCDOHMH in providing capacity building opportunities to providers, particularly programs that have been identified as having special challenges such as low VLS rates.
  • The QOC Program, working with NYCDOHMH Clinical Operations and Technical Assistance (COTA) program will develop TA material for HIV providers regarding evaluative frameworks for remote/telehealth HIV care.
  • The QOC Program has established several quality learning networks and NYLinks regional groups aimed at improving the health and well-being of PLWH and ending the epidemic in NYS.

QOC Program Standards outline the expectations for HIV providers in NYS, regardless of their caseload, location, or service delivery model. All HIV ambulatory programs are expected to establish a Quality Management program to assess the extent to which HIV health services provided to patients are consistent with these QOC Program Standards. QOC staff and coaches conduct annual organizational assessments of each HIV ambulatory care program in NYS annually to evaluate, track, and, support adherence to the QOC Program Standards.

In addition, QI Profiles are developed for high priority HIV programs that both receive an organizational assessment and submit their performance data. High priority programs are defined by case load and viral suppression rates. The profiles offer a succinct overview of longitudinal data results, organizational assessment results, and capacity building activities, and suggest opportunities for improvement.

AIDS Institute QI experts provide professional assistance to further strengthen quality management programs in HIV facilities throughout NYS.  They work with provider teams to set priorities for improvement initiatives and develop plans for quality improvement and ongoing internal quality monitoring. AIDS Institute staff and QI coaches provide education focusing on quality improvement methods, assist with the interpretation of data, and promote creative thinking by facility personnel to improve performance. 

Contacts:

Daniel Belanger, LMSW
Director, NYS Quality of Care Program
(212) 417-6131
daniel.belanger@health.ny.gov

For more information:
https://quality.aidsinstituteny.org/

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Clinical Guidelines Program

The Clinical Guidelines Program is a collaborative effort of the New York State Department of Health (NYSDOH) AIDS Institute, Office of the Medical Director (OMD), and the Johns Hopkins University (JHU) School of Medicine, Division of Infectious Diseases. Established in 1986 in response to the clinical management challenges of HIV/AIDS, the program has continuously addressed the HIV care and prevention needs of clinicians, supportive service providers, and consumers in New York State. In recent years, the AIDS Institute expanded its mission to support the efforts of those who provide medical care and services to LGBTQ people and to people living with hepatitis C virus (HCV), sexually transmitted infections (STIs), and substance use. The guidelines program has evolved to also address these expanding priority areas in addition to HIV care and prevention. 

AIDS Institute clinical guidelines are developed by committees of expert New York State clinicians. Committee members collaborate to survey and evaluate peer-reviewed literature, write and assess clinical recommendations, and update existing guidelines or create new guidelines as necessary to ensure that recommendations reflect current best practices. All new and revised guidelines undergo peer and consumer review.

Members of the committees use their expertise to evaluate important factors that determine treatment decisions, including potential benefits, risks, and burdens to the patient; patient views, values and preferences; feasibility and tolerability; and the quality of evidence supporting a treatment recommendation. All recommendations are assigned ratings based on the strength and quality of the supporting evidence. Current committees include:

  • Medical Care Criteria Committee (Adult and Adolescent HIV and related guidelines)
  • Hepatitis C Committee
  • Perinatal Transmission Committee
  • Substance Use Committee
  • Steering Committee

All new and updated guidelines are published on the open access website, www.hivguidelines.org, making them available to users throughout New York State and worldwide. Guidelines users can sign up for the program’s monthly newsletter, Topics, Trends, and Updates to receive a monthly email with notification of new guidelines or updates and other highlights from the Clinical Guidelines Program, including hot topics, events, What We’re Reading, trends in guideline use, and more. The Clinical Guidelines Program leadership, staff, committee members, and reviewers are committed to publishing guidelines that are used in the real world by busy care providers, who find them to be useful and readily accessible with immediate application in daily practice

Contact:

Laura Duggan Russell, MPH
Clinical Guidelines Program
Office of the Medical Director
(518)  473-8815
Laura.Russell@health.ny.gov

For more information:
https://www.hivguidelines.org

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Part A HIV Quality Management Program

The Ryan White Part A HIV Quality Management Program, a partnership with the New York City Department of Health Mental Health (NYCDOHMH) Care and Treatment program, focuses on supporting quality management capacity in programs receiving Part A funding in the New York Eligible Metropolitan Area (EMA), which includes New York City and Tri-county (Westchester, Rockland and Putnam counties). Mutual program goals are to improve the quality of supportive services, strengthen provider infrastructure, promote intersectional patient equity, and facilitate improvement activities at every stage along the HIV care continuum.

This program aligns the goals of quality management, program service objectives, evaluation, and patient outcomes in a consequential way. It is intended to increase the involvement of all program staff to broaden input and efforts toward improvement.

The Part A Quality Management Program continues to promote targeted coaching and support to assist providers in identifying quality infrastructure needs, provide guidance as needed in developing quality improvement projects and in selecting and testing changes, with the overarching goal to support and sustain quality efforts by building service provider capacity.  The program uses quality improvement consultants who demonstrate their expertise by working with programs to apply tools and methodologies. The Quality Management Program assists NYCDOHMH partners in the Care and Treatment program to promote health equity and more integrated quality management activities.

Each year, the program works in collaboration with NYCDOHMH Care and Treatment program to coordinate and present the Power of Quality Improvement conference. 

This conference provides a forum for peer learning and supports continued improvement efforts in Part A-funded programs. Approximately 300 people participate in this conference. Launched in 2014, this conference allows Ryan White Part A (RWPA)-funded programs to present quality improvement projects to one another and other key stakeholders in the EMA. 

The conference title – “The Power of Quality Improvement” – captures the spirit and emphasis of the day-long event.  RWPA providers from throughout the EMA are invited to submit abstracts and receive technical assistance from NYCDOHMH and AIDS Institute staff to develop ideas for presentation. RWPA providers also receive coaching to help them turn projects into presentations.  Many presentations highlight the distinctive role that providers of supportive services play to help people living with HIV (PLWH) engage in care and achieve viral load suppression. Peer learning drives the conference, providing an effective means to build capacity and stimulate improvement.

Contact:

Febuary D’Auria
Office of the Medical Director
631-851-3625
Febuary.DAuria@health.ny.gov

For more information:
https://quality.aidsinstituteny.org/QualImprove/QualImprove/AboutNYCPartAProgram

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AIDS Intervention Management System (AIMS)

The AIDS Intervention Management System (AIMS) program was created to meet federal and state quality of care requirements for health-related services provided to individuals enrolled in the New York State’s Medicaid program and all people living with HIV/AIDS.  Administered through a third-party contract, the AIMS program currently conducts quality of care reviews, program evaluations, focused clinical studies, and quality improvement activities for health related services rendered to individuals with or at risk of acquiring HIV/AIDS, hepatitis C (HCV), and/or sexually transmitted infections (STIs).  Such activities are typically conducted on acute, long term, ambulatory, and prison-based settings throughout the state.

The AIMS program is responsible for collecting, managing, and evaluating patient-level data to ensure that services provided are necessary, appropriate, equitable, and meet professionally-recognized standards of care—as well as identify emerging service needs to inform program and policy development. Examples of activities conducted by the AIMS program include:

  • Ambulatory Care Reviews: The AIMS program reviews the quality of care provided to individuals with or at risk of acquiring HIV/AIDS, HCV, and/or STIs at hospital outpatient departments and primary care provider sites.  Ambulatory care reviews address of a variety of health issues, including but not limited to HIV Testing, HCV, Pre-Exposure Prophylaxis (PrEP), and Post Exposure Prophylaxis (PEP).
  • Maternal-Pediatric Prevention and Care (MPPC): MPPC program reviews include the evaluation of care rendered to HIV-positive mothers and their HIV exposed newborns to monitor services intended to prevent perinatal transmission of HIV. 
  • Department of Corrections and Community Supervision (DOCCS) and County/Local Jails: The Department of Health (DOH) is required by state law to review policies and practices in DOCCS, county, and local jail facilities to ensure the care provided aligns with the HIV/AIDS and HCV clinical guidelines set forth by the DOH.

Contact:

Nina Inman, MSW
Health Program Administrator II
Office of Medicaid Policy and Health Care Financing
518-473-0032
Nina.Inman@health.ny.gov

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