Quality of Care Programs

New York State Quality of Care Program

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:

Contacts:

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

Clemens Steinböck, MBA
Director, Quality Improvement Initiatives
(212) 417-4730
clemens.steinbock@health.ny.gov

Daniel Tietz
Manager, Consumer Affairs
(518) 473-7542
daniel.tietz@health.ny.gov

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HIV Clinical Guidelines Program

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, write and assess clinical recommendations, and review and update 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 HIV and related guidelines)
  • Hepatitis C Committee
  • Perinatal Transmission Committee
  • Dental Standards of Care Committee
  • Mental Health Guidelines Committee
  • Substance Use Committee
  • Committee for the Care of Adolescents
  • Sexually Transmitted Infections Committee
  • Women with HIV Infection Committee
  • PrEP Advisory 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.

Contact:

Laura Duggan Russell, MPH
HIV Clinical Guidelines Program
(518)  473-8815
Laura.Russell@health.ny.gov

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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 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. 

Contact:

Tracy Hatton, MPH
Director, Part A HIV Quality Management Program
(212) 417-4617
tracy.hatton@health.ny.gov

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National Quality Center

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 National Quality Center (NQC) to serve as the primary national resource for quality improvement in HIV care. Since its inception in 2004, the NQC has provided national leadership and support in quality improvement for Ryan White Program-funded grantees nationwide and has become the premier technical assistance provider for federally funded HIV providers by meeting the demonstrated needs of Ryan White grantees for technical assistance in quality improvement principles and practice. The aim of this national initiative is to build capacity to improve the quality of HIV/AIDS care and services across the United States. The NQC delivers technical assistance through several modalities, including on-site coaching, peer learning opportunities, face-to-face trainings and dissemination of quality improvement resources. 

On-site technical assistance is delivered to grantees through a nationwide network of expert quality improvement coaches. Grantees request technical assistance from NQC on a number of quality improvement issues including conducting an organizational assessment of the quality management program, assisting in the development of a written quality management plan, providing staff training, developing and implementing performance measures and benchmarks, and reviewing data collection methodologies. The NQC serves close to 250 grantees nationwide across all Ryan White funding streams.

To foster local communities of learners, the NQC launched several cross-state collaboratives, which were modeled on the Institute for Healthcare Improvement’s (IHI) Breakthrough Series. The aims of these initiatives focused on alignment of 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. The Cross-Part Collaboratives involved five states (Connecticut, Texas, Virginia, Pennsylvania, and New Jersey) and all of the 86 Ryan White grantees, representing 19% of people living with AIDS in the U.S. Over the course of the Collaborative, collaboration and alignment across grantees improved, and all performance measures increased.

In 2011, NQC launched its first-ever national campaign, called in+care Campaign, engaging grantees across the U.S. in an effort to reengage those individuals who have been lost to care. This national retention initiative aligns with the goals of the National AIDS Strategy. The campaign has its own website, marketing materials, and a central data repository for grantees to enter their data and obtain benchmark reports. Approximately 51% of all Ryan White grantees are enrolled in the in+care Campaign, representing the largest quality improvement initiative in Ryan White history.

NQC has developed multiple face-to-face training opportunities for grantees. The NQC Training-of-Trainers (TOT) Program directly assists Ryan White Program grantees with building training capacity in quality improvement practice.  The TOT Program aims to increase the number of national quality improvement trainers and provides networking opportunities for participants with other HIV providers from across the country. The Training of Quality Leaders (TQL) Program provides participating grantees the ability to enhance their own expertise in quality management, the skills needed to work as facilitators to guide the development of sound quality management programs and/or quality improvement projects with impact on patient health outcomes, and group facilitation skills to better address team dynamics. The newest training program, 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. These advanced training programs have reached 56% of all Ryan White grantees.

NQC disseminates quality improvement resources through a variety of vehicles. The NQC website at NationalQualityCenter.org, which currently hosts over 300 materials and posts comprehensive and up-to-date HIV quality improvement resources for HIV providers and consumers. The NQC Quality Academy is an on-line resource on various topics in quality improvement and offers over 35 tutorials in English and Spanish. This resource has been used by grantees for staff training and is a rich source of materials specific to quality improvement in HIV care.  National technical assistance calls are offered monthly on a wide range of topics related to quality improvement.

For more information:

Contact:

Clemens Steinböck, MBA
Director, National Quality Center (NQC)
Office of the Medical Director
(212) 417-4730
clemens.steinbock@health.ny.gov

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HEALTHQUAL International

HEALTHQUAL International is a capacity building initiative that provides technical assistance, coaching, and mentoring directly to Ministries of Health to strengthen and improve national health systems with the goal of creating self-sufficient local quality management programs that are sustainable over time. Quality improvement activities involve clinic staff and consumers with support from Ministry of Health leadership.  These structural features are designed to be lasting even with staff turnover, organizational leadership changes or political transitions. HEALTHQUAL-International is funded through the federal government's President’s Emergency Plan for AIDS Relief (PEPFAR) in 14 countries in Africa, the Caribbean, South America, and Asia.  

HIVQUAL International was launched in Thailand in 2003, modeled on the NYS HIV Quality of Care Program and HIVQUAL-US initiative, expanding globally to PEPFAR participating countries including Uganda, Mozambique, Namibia, Haiti, Nigeria, Guyana, Kenya, Swaziland, Botswana, Rwanda, Zambia, Zimbabwe, Vietnam, and Papua New Guinea.   Based on the quality management model developed by the New York State Department of Health AIDS Institute in 1995, the HIVQUAL model has been successfully adapted by Ministries of Health and implemented by country teams throughout these regions. In 2010, HIVQUAL International transitioned to HEALTHQUAL, a programmatic development reflecting our expanded focus on a public health approach to quality management, including and extending beyond HIV care, to encompass other chronic and infectious diseases. HEALTHQUAL is characterized by a broader focus on population health to strengthen overall quality of care across national health systems.

HEALTHQUAL adapts three basic components of quality management – performance measurement, quality improvement, and the quality management program – into a national program directed by the Ministry of Health and led by teams who are mentored by HEALTHQUAL staff, augmented by peer learning models and patient involvement. This includes coaching, provision of training, technical assistance, paper-based tools and software to country programs for both monitoring and documentation of the quality of patient care. Staff and consumer involvement support government-led capacity for the scale-up of HIV treatment and care and advancement of overall population health.  Regional and district quality management groups foster implantation within structures of local government, creating expectations for ongoing, sustainable programs and rapid spread through peer learning.

For more information:  http://www.healthqual.org/

Contact:

Richard E. Birchard, MS
Deputy Administrative Director
HEALTHQUAL International
(212) 417-4749
richard.birchard@health.ny.gov

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AIDS Intervention Management System (AIMS)

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.

Contact:

Megan Tesoriero
Chronic Care Section
Phone: (518) 474-8162
Megan.Tesoriero@health.ny.gov

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