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ALABAMA DEPARTMENT OF PUBLIC HEALTH

Ryan White HIV/AIDS Program Part B

State Quality Management Plan

Clinical Quality Management Program April 1, 2017 – March 31, 2022

Alabama’s Ryan White HIV/AIDS Program Part B Clinical Quality Management Plan is a living document and will be updated and developed periodically. Revised March 2019

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INTRODUCTION The Ryan White HIV/AIDS Program (RWHAP) provides grant awards to assist State and Territories in developing access to continuous high quality comprehensive HIV Care and Treatment in order to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease. Title XXVI of the Public Health Service Act RWHAP Parts A-D requires the establishment of a Clinical Quality Management (CQM) program to:

Assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Service (PHS) guidelines, otherwise known as the Health and Human Service (HHS) guidelines; and

Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to, and quality of HIV services.

Alabama’s RWHAP Part B CQM Plan is delineated in this document. This CQM plan is a “living” document and will be updated and developed periodically for the expansion of the Ryan White Part B CQM programs. The CQM Plan is effective April 1, 2017 thru March 31, 2022. If you have any questions regarding this plan, please contact the CQM Program Manager or a state CQM Coordinator:

Bridget Reeder, CQM Program Manager Alabama RWHAP Part B Phone: 334-206-2774 Email: [email protected] Jackie Frost, CQM Coordinator Alabama RWHAP Part B Phone: 256-532-1920 Email: [email protected] Melissa McNeil, CQM Data Coordinator Alabama RWHAP Part B Phone: 334-206-9343 Email: [email protected]

http://hab.hrsa.gov/abouthab/legislation.html

mailto:[email protected]



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QUALITY STATEMENT

The Alabama Department of Public Health (ADPH), Division of HIV Prevention and Care (DHPC), RWHAP Part B Direct Care Services Branch, in collaboration with the Quality Management Committee, are committed to ensuring high quality care by improving patient care, health outcomes, and patient satisfaction for people living with HIV (PLWH). VISION STATEMENT The vision is to ensure a state with reduced HIV transmission and the elimination of health care disparities, promotion of consumer health advocacy including the self-empowerment to know, manage, and live ones best life possible. Alabama’s RWHAP Part B strives to provide a seamless system of access to comprehensive care and support services for all eligible PLWH in Alabama. MISSION STATEMENT Alabama’s RWHAP Part B CQM Program mission is to ensure all eligible PLWH in Alabama have access to high quality care and supportive services by:

Implementation of the CQM Plan; Ensuring Ryan White services are guided in accordance with PHS treatment guidelines and

standards of care; and Continued collaboration and coordination with sub-recipients, stakeholders, and

consumers to enhance patients’ access to care. ANNUAL QUALITY GOALS Goal 1: Implement and update annually the RWHAP Part B CQM Plan. Objectives:

1.1: Recipient will provide at least one quality improvement (QI) or quality management (QM) training annually to Ryan White Part B Providers based on identified QI needs. 1.2: Assure QI projects occur within at least one funded service category at the state or provider level at any given time. 1.3: Communicate QI project results to key stakeholders. 1.4: Develop a work plan and update on a quarterly basis. 1.5: Ensure sub-recipients submit Service Progress reports on a quarterly basis.

Goal 2: Improve the performance and efficiency of Alabama’s RWHAP Part B AIDS Drug Assistance Program (ADAP). Objectives:

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2.1: ADAP Application Determination – Ensure at least 75 percent of clients applying for ADAP enrollment are approved or denied within 14 days of receiving a completed application during the measurement year, with a plan to increase this percentage once achieved to meet or exceed HRSA performance measure of at least 90 percent. 2.2: ADAP Eligibility Recertification - To measure the percentage of ADAP enrollees who are reviewed for continued ADAP eligibility twice a year (i.e., annual birth month certification and partial half birth month recertification) during the measurement year, with a plan to meet or exceed 75 percent of ADAP clients re-certifying twice a year (every 6 months). 2.3: Collect, analyze, review and monitor programmatic compliance and adherence to antiretroviral regimens by assessing the percentage of ADAP clients who were virally suppressed (≤200 copies/mL) at the last viral load test during the measurement year using HIV surveillance data. 2.4: National HIV AIDS Strategy (NHAS) 2020 indicators - Continue accessing Alabama HIV Surveillance viral load data to ensure 90 percent of active ADAP enrollees are retained in care (≥ 2 clinical visit per measurement year) and 80 percent of active ADAP enrollees achieve viral suppression (≤200 copies/mL) during the measurement year.

Goal 3: Improve the quality of health outcomes and supportive services by implementing performance measures supportive of NHAS 2020 indicators. Objectives:

3.1: Monitor/review service categories performance measures for all Part B funded sites to assure they are current with HRSA/HAB policy clarification notices at least Annually and review the performance measure data quarterly at a minimum 3.2: Increase the percentage of newly diagnosed PLWH linked to HIV medical care within one month of their HIV diagnosis to at least 85 percent in the measurement year.

QUALITY MANAGEMENT INFRASTUCTURE KEY PERSONNEL

The State of Alabama through ADPH is the RWHAP Part B Grant Recipient. ADPH administers the grant through the DHPC, Direct Care Branch. The DHPC is located within the ADPH, Bureau of Communicable Disease (See Appendix 1).

Division of HIV Prevention and Care (DHPC) Director is responsible for the overall direction of the CQM Program in collaboration with the Direct Care Services Branch Director and the CQM Program Manager and Coordinators.

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Direct Care Services Branch Director serves as Alabama’s RWHAP Part B Director, including program administration, Part B provider (sub-recipient) relations, grant submission, program terms reports (PTR), annual progress reports (APR), and all programmatic and fiscal reporting requirements.

Senior Data Management Epidemiologist coordinates the transition of new or updated ADAP database and statistical analysis of client-level data for program planning, monitoring, improvement and development. Will assist in the collection and processing of performance measure data. Imports data from Alabama’s RWHAP Part B online ADAP application and the HIV Surveillance database into the ADAP database to ensure accurate and complete data reporting on all clients served through Alabama’s RWHAP Part B ADAP.

Financial Operations Branch Director, processes invoice payments made for Alabama’s RWHAP Part B, and monitors Part B provider (sub-recipient) contracts made through Alabama’s RWHAP Part B Lead Agency, the United Way of Central Alabama (UWCA).

Fiscal Services Administrator, in conjunction with Financial Operations Branch Director, DHPC Director and Direct Care Services Branch Director, monitors RWHAP Part B and ADAP funds in collaboration with Alabama’s RWHAP Part B Lead Agency (UWCA), submits 340 B rebates and pharmacy benefits manager (PBM), including fiscal reporting requirements.

CQM Program Manager oversees the State CQM Plan, coordinating day-to-day QM program operations; coordinating QM committee meetings; facilitating approval of performance measures by the Quality Management Committee; ensuring development, implementation, and evaluation of the QM plan and work plan; and revising the QM plan at least annually and the Work plan at least semi-annually. Also responsible for overseeing completion and submitting required reports related to QM.

CQM Coordinator is responsible for assisting with completion and submission of required reports related to QM, ensuring QM/QI and other HIV related training is available and conducted at least annually, assist with providing technical assistance to RWHAP Part B sub-recipients in the development of local QM plans, and conducting site visits to review QM plans, activities, and clinical performance indicators. Specialized area: ADAP/Part B core medical and support services CQM activities.

CQM Data Coordinator, conducts health-related data analysis utilizing statistical data management software for compliance with RWHAP Part B CQM performance measure reporting, submit quarterly area reports and Quality Improvement project data to the CQM Program Manager, and assist with presenting results at State QM quarterly meetings

ADAP Nurse Manager monitors enrollment and recertification of ADAP and Alabama Insurance Assistance Program (AIAP) clients for defined eligibility criteria, manages the eligibility specialists, communicates with Ryan White providers, conducts ADAP QI meetings at least twice annually, and ensures that Alabama’s RWHAP Part B is the payer of last resort.

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Part B Support Services Manager monitors enrollment and recertification of Medicare Part D clients assistance program (MEDCAP) clients for defined eligibility criteria and assumes the leadership role in collecting Part B core medical and support data. Monitors and adheres to programmatic requirements of all contracts and reporting requirements including QM activities in collaboration with the Lead Agency (UWCA).

Alabama’s RWHAP Part B contracts with one Lead Agency (UWCA) to oversee Part B core medical and support services fiscal and programmatic monitoring. The DHPC Director, Direct Care Services Branch Director and the Fiscal Services Administrator monitor RWHAP Part B funds in collaboration with the Part B Lead Agency (UWCA).

QUALITY MANAGEMENT COMMITTEE

The purpose of the Quality Management Committee (QMC) is to:

Provide oversight and facilitation of Alabama’s RWHAP ADAP/Part B and CQM Plan Provide a mechanism for the objective review, evaluation and continuing improvement and

uniformity of HIV care and support services throughout Alabama.

MEMBERSHIP Recognizing that individual members bring unique skill sets, each member will provide different roles in the development, implementation, evaluation and support of the CQM Program and written plan. Each member’s participation serves an important role in helping ensure accountability and standardization of efforts, identifying gaps in care and fostering collaboration and sharing knowledge for the benefit of improving patient health outcomes. Members of the QMC are expected to participate in at least one or more face-to-face meeting(s) annually and conference calls as needed.

COMPOSITION

The QMC is responsible for guiding the overall CQM Plan including determining priorities, setting goals, creating work plans, preparing reports and evaluating the program and plan. QMC membership is reviewed annually, with changes made accordingly, and includes the following members:

Direct Care Services Director Senior Data Management Epidemiologist CQM Program Manager CQM Coordinators ADAP Manager Part B Support Services Manager

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HIV Prevention and Care Integration Coordinator RWHAP Part B Lead Agency (UWCA) Staff HIV Surveillance Branch Director Part B Provider Sub-recipient Representatives Alabama Consumer Advisory Board (ACAB) Alabama Regional Quality Group Representatives Consumer(s)

In addition, a Quality Advisory Team has been identified and facilities advancing the culture of quality in our program through leadership and support in the development of the CQM Plan. The Quality Advisory Team is comprised of internal leadership who are dedicated to the QI process, the continuous guidance of the quality management plan and overall QI efforts in our CQM Program. The Quality Advisory Team includes:

Direct Care Services Director CQM Program Manager CQM Coordinators Senior Data Management Epidemiologist ADAP Nurse Manager Part B Support Services Manager Consumer(s)

Additional subcommittees will be created by the QMC as needed.

COMMUNICATION

The QMC will meet at least once quarterly to share performance measure data; which will assist with assessing the QI priorities and progress.

State Quality staff will share QM/QI findings and reports with sub-recipients during Alabama Partners in Care (APIC) Meetings at least twice a year.

Conference calls and e-mail communication will be ongoing as needed. Part B Quality projects will be shared with Alabama Regional Quality Group. The RWHAP Part B Direct Care Services Branch Director, Senior Data Management

Epidemiologist, CQM Program Manager, and/or CQM Coordinators will attend the Alabama Regional Quality Group quarterly meetings during the grant year.

The Alabama Regional Quality Group will report quality projects and outcomes to the QMC at least annually.

The Alabama HIV Prevention and Care Group (HPCG) meets once a quarter and CQM Program staff will provide updates on data, performance measurement outcomes, and quality projects at least once annually.

RESPONSIBILITIES

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The CQM Program Manager will serve as the main contact and team leader for the RWHAP Part B CQM Program.

The QMC is responsible for guiding the overall CQM Plan including determining priorities, setting goals, creating work plans, preparing and sharing data reports and evaluating the program and plan.

The Quality Advisory Team will: Determine the need for subcommittees and guide the subcommittee’s work plan. Actively participate in meetings, conference calls and other activities as needed. Determine performance measures and identify indicators to assess and improve

performance. Share findings with RWHAP Part B sub-recipients, other RWHAP funding Parts, DHPC

Director, and others. Review and update the CQM plan. Conduct/review evaluation activities. Make recommendations to the HIV/STD Program for appropriate education related

topics. Participate in at least two APIC meetings during the grant year. Participate in annual HIV Prevention and Care Collaboration Forum.

RESOURCES

Alabama’s CQM Program is supported by the RWHAP Part B grant The Southeast AIDS Education and Training Center (AETC) HIV Surveillance Branch Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Quality

Management Technical Assistance Manual and other quality improvement and outcome related documents.

Alabama RWHAP Part B providers Other ADPH personnel as needed Alabama’s RWHAP Part B Lead Agency (UWCA) The Implementation Center for Quality Improvement (ICQI) of HRSA/HAB and Target

Center for technical assistance, training and QI resources

PERFORMANCE MEASUREMENT SYSTEM

The following outlines the process for ongoing evaluation and assessment.

The QMC will determine quality projects and guide the process. Data will be collected, analyzed, and presented by the RWHAP Part B Direct Care Services

Director, the Senior Data Management Epidemiologist, and/or the Alabama Regional Quality Group each quarter.

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Data will be used to identify gaps in care and service delivery. The details for state level QI activities will be described in the CQM work plan. The QMC will present project data to all RWHAP Part B funded providers (sub-recipients),

the Alabama Regional Quality Group, Linkage Specialists, the Alabama Consumer Advisory Board (ACAB), ADPH DHPC staff, and the Alabama’s RWHAP Part B Lead Agency (UWCA), as well as during the APIC biannual meetings.

Evaluation of QI projects will be ongoing and the work plan will be updated at least semi-annually.

A systematic method of collection or CAREWare will be utilized whenever possible to collect statewide data for performance measures and to generate outcome reports as needed.

The QMC will annually assess the CQM Program for effectiveness.

COORDINATION WITH STATEWIDE QI ACTIVITIES

Coordination across Ryan White Programs and Parts:

The RWHAP Part B CQM Plan will focus on the collaboration of QM activities across all Ryan White Programs and Parts in Alabama.

The RWHAP Part B CQM Plan involves participation of members from Ryan White Parts B, C and D. The QMC includes members from Alabama Regional Quality Group and HIV Consumer representatives from State Linkages Specialist and ACAB members.

Coordination with ADPH RWHAP Part B staff, Lead Agency (UWCA), and RWHAP Part B providers (sub-recipients):

Alabama’s RWHAP Part B Direct Care Services Director, Senior Data Management Epidemiologist, ADAP Manager, Part B Services Manager, CQM Manager, and CQM Coordinators will attend the biannual APIC Meetings.

Alabama Regional Quality Group meetings are attended by RWHAP Part B Direct Care Services staff and the QMC will collaborate across RWHAP on QM activities, when possible.

Alabama’s RWHAP Part B Lead Agency (UWCA) staff will attend quarterly QMC meetings, when possible.

The QMC includes a member of the HIV Surveillance Branch. The QMC will collaborate with DHPC to focus on quality projects and reporting specific

project outcome data. Coordination with ADAP Quality Group (AQG):

The overall RWHAP Part B CQM plan will include all ADAP services. ADAP services include ADAP prescription only coverage (ADAP-Rx) as well as ADAP funded insurance assistance

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provided through the Alabama Insurance Assistance Program (AIAP) and the Medicare Part D client assistance program (MEDCAP).

The ADAP Manager and Part B Support Services Manager are members of the QMC, and also oversee the ADAP Quality Group (AQG) to plan ADAP improvement activities.

MEASUREMENT YEAR The measurement year is the time period defined by the grant year, from April 1 to March 31 on an annual basis. HRSA/HAB RWHAP Part B announced conversion to a five year funding cycle, beginning April 1, 2017. The first five year project period will provide funding on an annual basis beginning April 1, 2017 through March 31, 2022. The following definitions are used in the ADAP Program: ACTIVE ADAP CLIENT DEFINITION

Client enrolled into ADAP program and/or client is eligible Client received at least one ADAP-Rx prescription medication during the reporting period. Client received AIAP or MEDCAP premiums, co-pays and/or deductibles during the reporting

period. Client enrolled in ADAP who attended one or more medical visit during the reporting period. Note: ADAP clients include ADAP-Rx, AIAP, and MEDCAP clients.

ACTIVE PART B CLIENT DEFINITION

Client enrolled to receive Part B core medical and support services. Enrollment date begins upon approval of application. Client receives at least one RWHAP Part B core medical and/or support service during

reporting period. AGE LIMIT DEFINITION

Client meets active client definition Client is 18 years or older during the entire 12 months of the calendar year

MEDICAL VISIT DEFINITION

An HIV care setting is one which received Ryan White HIV/AIDS Treatment Modernization Act of 2006 funding to provide HIV care and has a quality management program in place to monitor the quality of care addressing gaps in quality of HIV care.

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A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe antiretroviral therapy (ART), such as a medical doctor (M.D.), physician’s assistant (P.A.), or nurse practitioner (N.P.).

PERFORMANCE MEASURES In accordance with HRSA/HAB, the use of data and measurable outcomes is to determine progress and make improvements to achieve the aims of the CQM Program. Performance measurement will be a continuous process to be reviewed on a quarterly basis. Each service category is cited with two or more measurement outcomes; indicators to be measured; data elements used to measure the indicator; data sources and methods; and analyzes and review of the data is noted. The following tables describe details of the performance measures supporting specific stages of the HIV Care Continuum aligned with National HIV/AIDS Strategy (NHAS) 2020 Indicators:

1. Linkage to Care, NHAS 2020 indicator - 85 percent linked to care within 1 month 2. Retention in Care, NHAS 2020 90 percent retained in HIV medical care 3. Viral Suppression, NHAM 2020 indicator – 80 percent virally suppressed

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Service Category: AIDS Drug Assistance Program (ADAP) Treatments Ryan White Services Report (RSR): Service ID Not Available Measurement Outcome Indicator to be Measured Data Elements used to

Measure Indicator Data Source & Methods Analyzing & Reviewing

Data Eligibility Recertification: ≥ 90 percent of ADAP enrollees are reviewed for continued ADAP eligibility two or more times in the measurement year.

Support of retention in care: ≥1 medical visit in each 6-month period of the 24-month measurement period, occurring at least 60 days apart

National HIV/AIDS Strategy (NHAS) 2020 indicator of 90% retention in care

ADAP database, ADAP Data Report (ADR), ServisPoint online ADAP application, RWHAP Part B Provider (sub-recipient) Data, eHARS HIV Surveillance Data, other Data Collection Methods

Direct Care Services Director, Senior Data Management Epidemiologist, CQM Program Manager, Part B Services Manager, RWHAP Part B Providers

Application Determination:

≥80 percent of ADAP applications are approved or denied for new ADAP enrollment within 14 days (two weeks) of ADAP receiving a complete application in the measurement year.

Part B Collaborative: complete applications approved or denied within 14 days Support of viral load suppression: Viral load <200 copies/mL at most recent viral load test collected during the 12-month measurement period.

Part B Collaborative: 97 percent National HIV/AIDS Strategy (NHAS) 2020 indicator of 80% viral suppression.

RWHAP Part B Provider (sub-recipient) Data, eHARS HIV Surveillance Data, other Data Collection Methods


Service Category: Outpatient/Ambulatory Health Services (OAHS) Ryan White Services Report (RSR): Service ID 8 Measurement Outcome Indicator to be Measured Data Elements used to


Data HIV Medical Visit Frequency: ≥ 90 percent of patients, regardless of age, with a diagnosis of HIV who had at least one medical visit in each 6-month period of the 24-month measurement period with a minimum of 60 days between medical visits.





HIV Viral Load Suppression: ≥ 80 percent of patients, regardless of age, with a diagnosis of HIV with an HIV viral load less than 200 copies/mL at the last HIV viral load test during the measurement year.

Support of viral load suppression: Viral load <200 copies/mL at most recent viral load test collected during the 12-month measurement period.

National HIV/AIDS Strategy (NHAS) 2020 indicator of 80% viral suppression.



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Service Category: Oral Health Care (OHC) Ryan White Services Report (RSR): Service ID 10 Measurement Outcome Indicator to be Measured Data Elements used to


Data Dental and Medical History: ≥ 90 percent of HIV-infected oral health patients have a dental and medical health history (initial or updated) at least once in the measurement year.





Dental Treatment Plan: ≥ 80 percent of HIV-infected oral health patients have a dental treatment plan developed and/or updated at least once during the measurement year.





Service Category: Early Intervention Services (EIS) Ryan White Services Report (RSR): Service ID 11 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Health Insurance Premium (HIP) and Cost Sharing Assistance (CSA) for Low-Income Individuals Ryan White Services Report (RSR): Service ID 12 Measurement Outcome Indicator to be Measured Data Elements used to












Service Category: Mental Health Services (MHS) Ryan White Services Report (RSR): Service ID 16 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Medical Nutrition Therapy (MNT) Ryan White Services Report (RSR): Service ID 17 Measurement Outcome Indicator to be Measured Data Elements used to












Service Category: Medical Case Management (MCM), Including Treatment Adherence Services (TAS) Ryan White Services Report (RSR): Service ID 18 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Substance Abuse Outpatient Care (SAOC) Ryan White Services Report (RSR): Service ID 19 Measurement Outcome Indicator to be Measured Data Elements used to












Service Category: Non-Medical Case Management Services (NMCMS) Ryan White Services Report (RSR): Service ID 20 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Emergency Financial Assistance (EFA) Ryan White Services Report (RSR): Service ID 23 Measurement Outcome Indicator to be Measured Data Elements used to












Service Category: Food Bank/Home Delivered Meals (FB/HDM) Ryan White Services Report (RSR): Service ID 24 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Health Education/Risk Reduction (HE/RR) Ryan White Services Report (RSR): Service ID 25 Measurement Outcome Indicator to be Measured Data Elements used to












Service Category: Housing Ryan White Services Report (RSR): Service ID 26 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Other Professional Services (OPS) Ryan White Services Report (RSR): Service ID 42 Measurement Outcome Indicator to be Measured Data Elements used to












Service Category: Linguistic Services (LS) Ryan White Services Report (RSR): Service ID 28 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Medical Transportation (MT) Ryan White Services Report (RSR): Service ID 29 Measurement Outcome Indicator to be Measured Data Elements used to












Service Category: Psychosocial Support Services (PSS) Ryan White Services Report (RSR): Service ID 32 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Referral for Health Care (RHC) and Support Services (SS) Ryan White Services Report (RSR): Service ID 33 Measurement Outcome Indicator to be Measured Data Elements used to












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Service Category: Minority AIDS Initiative (MAI) Ryan White Services Report (RSR): Service ID Not Available Measurement Outcome Indicator to be Measured Data Elements used to


Data ≥ 85 percent of clients receiving RWHAP-funded MAI Services were linked to care through Outreach during the 12 month measurement year, with support provided by Alabama Peer Linkage Specialists in collaboration with HIV Program Coordinators

Minority clients who received MAI funded outreach and/or educational services that were enrolled in ADAP Support of linkage to care: Linked to care within 30 days of initial HIV diagnosis.

Increase in the percentage of minority clients linked to care through enrollment in ADAP National HIV/AIDS Strategy (NHAS) 2020 indicator of 85% linkage to care

CommCare Peer Linkage Specialist App, ServisPoint online ADAP application, eHARS HIV Surveillance Data, other Data Collection Methods


≥ 85 percent of clients receiving RWHAP-funded MAI Services were linked to care through Education during the 12 month measurement year, with support provided by Alabama Peer Linkage Specialists in collaboration with HIV Program Coordinators.

Percentage of minority clients receiving MAI services prescribed antiretroviral (ARV) medications for HIV infection during the measurement year (modified HAB/HHS Antiretroviral Therapy Measure). Example: Of the HIV+ minorities who received RWHAP Part B MAI funded outreach or education services, the percent of these clients who were prescribed ARV medications during the measurement year. Support of viral load suppression: Viral load <200 copies/mL at most recent viral load test collected during the 12-month measurement period.

Increase in the percentage of minority clients prescribed ARV National HIV/AIDS Strategy (NHAS) 2020 indicator of 80% viral suppression.

CommCare Peer Linkage Specialist App, ServisPoint online ADAP application, eHARS HIV Surveillance Data, other Data Collection Methods


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IMPLEMENTATION CQM Work Plan will be developed and revised on an annual basis by the Quality Advisory Team and QM Committee. The CQM Work Plan will consist of objectives, strategies, assignments, milestones and timelines. DATA COLLECTION enhanced HIV/AIDS Reporting System

(EHARS) HIV/AIDS Data Information Systems (HADIS) ADAP Database ADAP Data Report (ADR) Ryan White Service Reports (RSR)

Enhanced Referral Tracking System (ERTS)/Patient Reengagement

UWCA ServisPoint UWCA Web-based CAREWare host Provider sub-recipient reports Client Satisfaction Surveys MAI/Peer Linkage Specialist

REPORTING MECHANISMS

Sub-Recipients will report data on performance through RW Contract reports The Quality Advisory Team will review and compile findings Findings will be shared with Lead Agency, Sub-Recipients, Alabama Regional Quality

Group, Consumers, and other stakeholders Process to evaluate assess, and follow-up on findings will be established by RWHA Quality

and Part B Program staff and will conduct oversight and ensure implementation process Findings will assist with development of new Quality Improvement activities/projects

QUALITY IMPROVEMENT PROJECTS

The state Quality Management Committee (QMC) and Alabama Regional Quality group will utilize data to determine prioritized QI projects

Continuous Quality Improvement Methodology will be utilized including: o Plan Do Study Act Model

(PDSA) o Flow Chart Analysis o Cause and Effect Diagrams o Brainstorming

o Observational studies/patient flow

o Activity Logs

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CAPACITY BUILDING

Building capacity in Quality management consists of the spread of performance measurement systems and improvement activities by identifying methods of training and provision for technical assistance on quality management. Capacity is necessary to meet HRSA HAB reporting requirements which includes collection of accurate data and to share data to determine QI needs. The following training methods will be used for RW Part B Sub-recipients:

Regional Quality Coordinators to provide QM training to sub-recipients as needed. Center for Quality Improvement and Innovation (CQII) HRSA HAB training Target Center for materials and resources

Project Person Responsible Data Source and Method Provide QM 101 training to MCMs QM Manager and QM

Coordinators CQII Training and Target Center website

QUALITY MANGEMENT EVALUATION

The Quality Management Evaluation process is designed to assist in determining whether the program is making significant improvements. The CQII HRSA/HAB consultants and Ryan White Part B and C Quality Management Assessment tool will be used at least annually by QMC and RW Part B sub-recipient and collaborative cross-parts. The QMC will also be responsible for the following quality management evaluation process:

To determine the effectiveness of the QM Programs infrastructure and activities and assesses whether or not these led to expected improvements and desired outcomes.

Assess access to data, at least by service category and drive improvements Reviewing annual goals and identifying those that have been met and those not met and

determine the reasons they were not met. Reviewing appropriateness of measures and identifying whether there is a need for new

measures.

The evaluation process is diagramed below.

Process Timeline Agreement Process Where appropriate Alabama to use external (other states) data for comparison/ evaluations

Annual QM Committee meeting(s)

QM Committee members will complete the National Quality Center/HAB RW Part B Quality Management Program Assessment during face to face meeting. The QM Manager and QM Coordinators will cumulate the assessments and present results at next meeting.

Annually at the face to face QM Committee meeting

Consensus voting allowing for follow up when full consensus is not achieved

Distribute the following questions to QM Committee to be discussed during yearly meetings:

Annually at the face to face QM Committee meeting

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1. What QI goals were achieved during the previous

measurement year? 2. a) What clinical measure goals were met in

previous measurement year? b) Are results in the expected range? If so, how?

3. a) What MCM/ADAP goals were met in previous measurement year? b) Are results in the expected range? If so, how?

4. How were stakeholders informed? 5. Did our current infrastructure work? 6. Did we do what we said we were going to do for

each measure and each QI project? Why? Why not?

7. Are our measures meaningful to helping us understand HIV care systems in Alabama? Are they helping us identify whether or not we need to make changes?

UPDATING THE CLINICAL QUALITY MANAGEMENT PLAN

The CQM Plan is essential to the Ryan White Part B Program and coordinating Cross-Parts. The Plan will be updated in a systematic and consistent process. The following method will be used:

Quality Advisory Team and Quality Management Committee (QMC) will discuss updates during meetings and via conference calls on a semi-annual basis

Quality Advisory Team and QMC members will propose performance measurements and QI projects to Direct Care Quality staff during face to face Regional and State Quality meetings

Process Timeline Agreement Process Ryan White Part B and working group will discuss needed updates to the QM Plan during our semi-annually meetings and on conference calls as needed

On going Proposed updates to the QM Plan will be shared with the QM Committee

QM Committee members and stakeholders will bring proposed QI projects and performance measurements to the attention of the QM Manager and QM Coordinators to be addressed at the QM Committee face-to-face meetings

On going Consensus voting allowing for follow up when full consensus is not achieved

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Appendix 1

QUALITY MANAGEMENT INFRASTUCTURE

Leadership

Sharon Jordan, Division of HIV Prevention and Care (DHPC) Director

Allison Hatchett, Direct Care Services Branch Director

Izza Cagle, Senior Data Management Epidemiologist

Valerie Patton, Financial Operations Branch Director

Anethea Robinson, Fiscal Services Administrator

Bridget Reeder, CQM Program Manager

Jackie Frost, CQM Social Work Coordinator

Terri Jenkins, CQM Nurse Manager

Gloria Sims, Part B Support Services Manager

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