Quality of Care Programs
- NYS Quality of Care Program
- HIV Clinical Guidelines Program
- Part A HIV Quality Management Program
- Center for Quality Improvement Innovation (CQII)
- AIDS Intervention Management System (AIMS)
The AIDS Institute is committed to promoting, monitoring, and supporting the quality of clinical services for people with HIV in New York State. The Office of the Medical Director coordinates quality improvement activities including the development of clinical performance measures derived from practice guidelines, on-site quality of care reviews, as well as the promotion of quality improvement activities, peer learning opportunities for HIV providers, and consultations to support on-site quality improvement efforts. The ultimate objective for each HIV program in New York State remains the development of a sustainable independent quality management program that reflects the capacity to dynamically analyze and continuously improve HIV treatment, care, and supportive services.
The Office of the Medical Director coordinates the participation of several groups of stakeholders to accomplish these tasks, including: (1) internal Quality of Care Workgroup based at the AIDS Institute, responsible for implementation and refinement of the program within the New York State Department of Health AIDS Institute; (2) AIDS Institute's Medical Care Criteria Committee chaired by Dr. Samuel Merrick, MD, responsible for clinical guidelines development; (3) HIV Quality of Care Clinical Advisory Committee chaired by Dr. Peter Gordon, comprised of expert HIV providers who advise on the development, implementation, and refinement of the Quality of Care Program; (4) New York City Part A Quality Management Program Advisory Committee; and (5) AIDS Institute's Consumer HIV Quality Committees. The AIDS Institute solicits feedback through these committees in planning, implementing, and evaluating quality of care program activities. The interaction of providers and consumers with the AIDS Institute through these various groups allows New York State to remain responsive to the needs of the communities that it serves, while responding to changes in clinical and scientific knowledge.
Statewide quality of care program standards that apply to all HIV health care facilities, regardless of their caseload, location or service delivery model have been developed, reviewed annually, and revised as needed. These standards ensure that the best clinical care is provided to patients throughout New York State by improving systems of care delivery and by stimulating quality monitoring. In addition to medical chart reviews, organizational assessment tools have been created to determine the extent to which these program standards have been implemented. Annual assessments of providers’ quality management programs are conducted by AIDS Institute staff and consultants. Data from these assessments are used to guide technical assistance and consultation to further enhance providers’ quality management programs and to develop future strategies to advance the statewide Quality of Care Program. Statewide and regional organizational assessment reports are developed and reviewed annually to identify areas of common need. Workshops, webinars and other opportunities for capacity building and peer learning are developed based on these findings.
All HIV programs throughout New York State are expected to self-report their quality of care performance data. The HIVQUAL review is completed online using the eHIVQUAL application. HIV programs can submit completed reviews online and instantly access performance data results, allowing them to immediately utilize the data findings to prioritize upcoming quality activities.
Facility-based results of the quality of care reviews are presented as aggregate data. Results for specific regions in New York State are provided as well, in a format that permits comparative evaluation and reference to performance standards while maintaining patient confidentiality. The results are used to target providers for assistance and consultation, rather than to penalize. In addition, Quality Improvement Profiles are developed for HIV programs that both receive an organizational assessment and submit their performance data. These profiles offer a succinct overview of longitudinal data results, organizational assessment results, and capacity building activities, and suggest opportunities for improvement.
AIDS Institute quality improvement experts provide professional assistance to further strengthen quality management programs in HIV facilities throughout New York State. They work with clinicians and administrative staff 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.
The Quality of Care Program has established several Care Regional Groups and Learning Networks. These involve quarterly meetings that emphasize peer interactions and learning. Structured meetings focus on quality management using existing performance measurement strategies, as well as group improvement projects. In addition to the face to face meetings, participants take part in webinars and regularly submit data reports on ongoing improvement activities. The goals of these groups are to improve the quality of HIV services, strengthen provider infrastructure, and increase competency in performance measurement. Ambulatory care groups currently engaged in these collaborative activities include New York City Health and Hospitals Corporation hospitals, drug treatment centers with HIV primary care, several upstate hospitals and community health centers, and adolescent providers. These groups and learning networks also provide a forum for work on group improvement projects.
The HIV Quality of Care Program continues to engage people living with HIV/AIDS (PLWHA). The HIV Quality of Care Consumer Advisory Committee has been focusing its attention on the following areas: involvement of consumers in quality activities, as well as the needs and concerns of the deaf and hard of hearing community. In 2007, a Youth Committee was formed to solicit feedback from HIV-infected adolescents and to routinely present concerns of the Youth Committee to AIDS Institute committees. Consumer Advisory Committee members continue to review upcoming adult, adolescent and pediatric clinical guidelines developed by the HIV Clinical Guidelines Program.
Recent areas of emphasis for these programs have included improving viral load suppression rates, patient retention, and maximizing use of clinical information systems to produce performance data. Annual New York State Quality Awards honor those quality champions who have excelled in areas of quality such as performance measurement, quality improvement and consumer involvement.
For more information:
Daniel Belanger, LMSW
Director, NYS Quality of Care Program
Clemens Steinböck, MBA
Director, Quality Improvement Initiatives
Manager, Consumer Affairs
The Office of the Medical Director directly oversees the development and dissemination of the guidelines produced by the Clinical Guidelines Program. Established in 1986, during its thirty-year history, the program has continuously addressed the HIV care and prevention needs of clinicians, supportive service providers and consumers in New York State. In line with the expanded mission of the AIDS Institute, the program is intended to support clinicians who treat people with HIV infection as well as those involved in preventing HIV, and those who manage patients with viral hepatitis and sexually transmitted infections. The program also addresses LGBT health and the health of persons who use drugs.
AIDS Institute clinical guidelines are developed by committees of expert NYS clinicians who identify topics within their area of focus, writing and assessing clinical recommendations, and reviewing and updating existing guidelines as necessary to keep information current with any emerging clinical and research developments. All new and revised guidelines undergo peer review and are also reviewed by consumers.
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
- Sexually Transmitted Infections Committee
- Steering Committee
All new and updated guidelines are posted on the open access website, www.hivguidelines.org, making them available to users throughout New York State and worldwide. The Clinical Guidelines Program works in a coordinated manner with other programs in the AIDS Institute to promote the implementation of HIV guidelines in New York State.
Laura Duggan Russell, MPH
HIV Clinical Guidelines Program
The Ryan White Part A HIV Quality Management Program, a partnership with the New York City Department of Health and Mental Hygiene, focuses on building quality management capacity in programs receiving Part A funding in the New York Eligible Metropolitan Area, which includes New York City and Westchester, Rockland and Putnam counties. Mutual program goals are to improve the quality of supportive services, strengthen provider infrastructure, and facilitate improvement activities at every stage along the HIV care continuum.
This program aligns the goals of quality management, service program objectives, evaluation, and patient outcomes in a significant way. It is intended to increase the involvement of all program staff and consequently broaden input and efforts toward improvement. The Part A HIV Quality Management Program works with individual programs to develop and conduct quality improvement projects intended to improve services not only in supportive areas but also to encourage integration with clinical services to promote ending the epidemic objectives such as viral load suppression.
The Part A HIV Quality Management Program promotes targeted coaching and support to assist providers as needed in identifying quality infrastructure needs, and provides guidance as needed in developing quality improvement projects and in selecting and testing changes, with the overarching goal to support and sustain quality efforts in Part A programs by building service provider capacity.
Tracy Hatton, MPH
Director, Part A HIV Quality Management Program
The New York State Department of Health AIDS Institute is funded by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau to develop and implement the
HRSA Ryan White HIV/AIDS Center for Quality Improvement & Innovation (CQII). CQII serves as a national technical assistance resource to provide state-of-the-art technical assistance to Ryan White HIV/AIDS Program (RWHAP)-funded recipients and subrecipients to measurably strengthen local clinical quality management programs to impact HIV health outcomes. The AIDS Institute was newly funded in July 2017 to manage CQII after operating the National Quality Center (NQC) since 2004.
CQII provides four levels of technical assistance to RWHAP recipients and subrecipients:
- Information Dissemination: monthly newsletters, websites, quality improvement publications, exhibits at HIV or quality improvement, annual awards to highlight quality improvement champions
- Training and Educational Forums: monthly technical assistance webinars, advanced trainings, online quality improvement tutorials
- Consultation: On/off-site coaching of recipients and subrecipients to advance their clinical quality management programs
- Communities of Learning: implementation of national quality improvement collaborative to address HIV-related public health priorities
On/off-site technical assistance is delivered to recipients through a nationwide network of expert quality improvement consultants. RWHAP recipients or subrecipients request technical assistance using a standardized Technical Assistance Request Form and submit the completed form to HRSA for their review and approval. The provision of technical assistance allows recipients and subrecipients to be in alignment with Policy Clarification Notice #15-02 issued by HRSA in 2015.
CQII implements multiple face-to-face training opportunities for recipients/subrecipients. The CQII Training-of-Trainers (TOT) Program directly assists RWHAP providers with building training capacity in quality improvement practice. The Training of Quality Leaders (TQL) Program provides participants the ability to enhance their own expertise in clinical quality management so they can lead the local quality improvement efforts. The Training on Coaching Basics (TCB) Program aims to close any educational gaps of quality managers and to increase quality improvement competencies by building the quality improvement capacity of quality leaders to coach other HIV providers on quality improvement. The Training for Consumers on Quality (TCQ) focuses on providing consumers the information they need to become informed members of an organization’s clinical quality management program. The demand for the delivery of the TCQ throughout the country necessitated the development of the Training for Consumers on Quality Plus (TCQPlus) to teach training partners (consumers and providers participants) how to deliver effective TCQ sessions. By pairing up to three consumers and a HIV provider, the Program ensures comprehensive consumer involvement as well as the opportunity for consumer-trainers to actively participate in the local quality management activities.
To foster local communities of learners, CQII launched several cross-state collaboratives, which were modeled on the Institute for Healthcare Improvement’s (IHI) Breakthrough Series. The aims for these initiatives focused on alignment of clinical quality management goals to cooperatively meet the federal legislative mandates, and to advance the quality of care for people living with HIV within the respective constituencies. Currently, CQII implements the end+disparities Project Extension for Community Health Outcomes (ECHO) Collaborative. This national initiative builds on the success of past National Quality Center (NCQ) collaboratives and incorporates the expertise of Project ECHO, housed at the University of New Mexico. The goal of the Collaborative is to reach one in three RWHAP-funded-recipients across the nation and decrease the number of people living with HIV who are not virally suppressed by 25% from baseline reports at the onset of the Collaborative.
For more information:
Clemens Steinböck, MBA
Director, National Quality Center (NQC)
Office of the Medical Director
The AIDS Intervention Management System (AIMS) was created in 1986 to collect, organize, and evaluate data associated with the care of HIV-infected patients. AIMS is responsible for utilization reviews for HIV-related inpatient stays and Medicaid-funded ambulatory care; quality of care reviews for HIV Special Needs Plans enrollees and others as requested by AI leadership or the Office of the Medical Director; and analysis and reporting of data gathered through all review activities and special studies.
The goals of the AIMS program, currently administered through a third-party contract include:
- creation of a review process that ensures services are necessary, appropriate, and meet professionally-recognized standards of care;
- development and management of data systems that support review activities and permit program evaluation and policy development; and
- identification of service needs and development of mechanisms to address shortcomings or inefficiencies.
During contract year ending March 31, 2014, AIMS conducted approximately 94,064 reviews, including 37,019 quality-of-care reviews, 24,225 utilization reviews, up to 2400 maternal-pediatric HIV prevention and care program reviews, 883 DOCCS reviews and 32,820 Special Needs Plans program reviews. All quality-of-care reviews were conducted at ambulatory care sites. Reviews were conducted at acute care providers other than Designated AIDS Centers to assure that all New Yorkers with HIV receive clinically appropriate services regardless of site. The unit monitors SNP contract compliance and conducts quality of care reviews at ambulatory care sites in SNP provider network. Currently reviews have been expanded to include HIV testing in emergency rooms as well as study of HIV care management by agencies contracting with Health Homes.
Chronic Care Section
Phone: (518) 474-8162