WELCOME Systems Linkages and Access to Care for Populations at High Risk for HIV Infection in New York State

Transcription

1 Queens and Staten Island Regional Group First Learning Session February 22 nd, 2013 WELCOME Systems Linkages and Access to Care for Populations at High Risk for HIV Infection in New York State

2 Welcome and Opening Remarks Monica Sweeney, MD, MPH Ira Feldman, NYSDOH AIDS Institute Johanna Buck, RN, MA Lenee Simon, MPH Clemens Steinböck, MBA

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23 HRSA HIV/AIDS Bureau Special Projects of National Significance Systems Linkages and Access to Care for Populations at High Risk for HIV Infection in New York State Clemens Steinböck, NYS Director of Quality Initiatives

24 SPNS Overview

25 Engagement in Care Continuum Non Engager Sporadic User Fully Engaged [1] Health Resources and Services Administration, HAB. August Outreach: Engaging People in HIV Care Summary of a HRSA/HAB 2005 Consultation on Linking PLWH Into Care. [2] Eldred L, Malitz F. Introduction [to the supplemental issue on the HRSA SPNS Outreach Initiative]. AIDS Patient Care STDS 2007; 21(Suppl 1):S1 S2.

26 What is SPNS? Special Projects of National Significance Part of the national Ryan White HIV/AIDS Program Supports the development of innovative and sustainable systemic models to improve linkage to and retention in quality HIV care through implementation of quality improvement collaboratives 4-year funding cycle awarded to seven states Strong evaluation/research component to assess the effectiveness of models, and then focus on the dissemination and replication of successes at a state and national level

27 Formal Evaluation NY Links evaluation conducted by CUNY School of Public Health at Hunter College Dr. Denis Nash, Diane Addison National SPNS evaluation by ETAC UCSF Using NYS/NYC surveillance data for local linkage/retention analyses Identification of proven linkage/retention interventions and spread to other NYS HIV providers

28 NYS Links Overview

29 NYS Links Mission We identify and spread innovative solutions for improving linkage to and retention in HIV care that support the delivery of routine, timely, and effective care for PLWHA in New York State. We will bridge systemic gaps between HIV related services and achieve better outcomes for PLWHA through improving systems for monitoring, recording, and accessing information about retention and linkage to HIV care in NYS.

30 Existing Collaboratives in New York State Nanette Brey Magnani, Director Susan Weigl, Director Johanna Buck, Lenee Simon; Directors

31 UM Regional Group Engagement of all medical and non medical providers in the Upper Manhattan geographic area to improve linkage to and retention in HIV care Expectations for participation: Quarterly face to face meetings Routine data submission of standardized indicators Implementation of QI interventions to address internal and cross agency linkage/retention challenges Blue Clinical Program Participating in the Upper Manhattan Regional Group Yellow Supportive Service Program Participating in Upper Manhattan Regional Group

32 Western New York State Collaborative Red Programs Participating in the WNYS Regional Collaborative Engagement of all HIV medical and nonmedical providers in the Western NY geographic area (Rochester and Buffalo) to improve linkage to and retention in HIV care. Initiated 6/12 Current progress: 3 rd Learning session scheduled for February 2013 Providers working on utilizing data, as a system and individually, to locate areas where interventions would have the most impact Some providers working on improving tracking systems for better identification

33 Queens-Staten Island Collaborative Engagement of all HIV medical and nonmedical providers in the Queens and Staten Island geographic area to improve linkage to and retention in HIV care. Initiated 2/13 Current progress: Kick Off Learning Session on February 22, 2013 Introduce providers to the goals and objectives of this Collaborative Generate momentum to jointly work on linkage and retention interventions

34 Overview of NY Links Measures Measure Linkage Retention New Patient Retention Clinical Engagement New Client Clinical Engagement Agency Type All Programs that Conduct HIV Testing HIV Clinical Care Supportive Service, General Medical & Dental

35 Linkage and Retention Interventions Currently Being Tested by Providers Upper Manhattan Care Management (Patient/Peer Navigators) Development of tracking systems Improved/New linkage handoffs Same Day Service delivery Staff Training Outreach Patient Support Western New York Care Management (Patient/Peer Navigators) Data analysis System analysis Referral and MOUs Linkage agreements Patient Support

36 37 Collaborative Response Team

37 Collaborative Response Team A Collaborative Response Team is a self-organizing, peer-driven group made up of 5-10 nominated leaders with complementary skill sets and roles from among each NYS Collaborative membership. Purpose: Streamline communication across teams Strengthen leadership capacity in the Collaborative Support & direct Collaborative activities Increase sustainability beyond the Collaborative 38

38 Queens-Staten Island Response Team Members Wanted! Expectations: Conduct regular team meetings Share information routinely with collaborative body Participate in Collaborative planning efforts Report back on collaborative progress to constituents Membership: Cross-agency & cross-provider category Reflects various functional skill needs of the Collaborative Composition and core roles flexible based on needs of the Collaborative Membership determined by Collaborative participants 39

39 NY Links Website

40 Key Contacts Johanna Buck, NYSDOH, Senior Quality Consultant Overall guidance for Q&SI Collaborative, lead for technical assistance Lenee Simon, NYCDOHMH, Senior Program Manager Lead for coordination with NYCDOHMH, liaison with Response Team Steven Sawicki, NYSDOH, SPNS Lead Overall guidance of NY Links initiative, coordination with other Collaboratives

41 With Gratitude to the Teams Monica Sweeney, MD Graham Harriman Andy Doniger, MD Byron Kennedy, MD, MPH Gale Burstein, MD, MPH Kim Smith Cheryl Moore Roger Hayes Terry Hamilton Lou Smith, PhD Dan Gordon, PhD John Fuller Mary Irvine Nanette Brey-Magnani Susan Weigl Denis Nash, PhD Diane Addison Rebekkah Robins Inez Jones Dan Tietz Carol-Ann Watson Annelise Herskowitz Cameron Stainken Meredith Baumgartner Dennis Tsui Johanne Morne

42 Contact Information Clemens Steinbock, NYS Director of Quality Initiatives Bruce D. Agins, MD, MPH, Medical Director General NY Links information

43 Break

44 Building a System to Link and Retain Patients: Small Group Work Johanna Buck, RN, MA Table Facilitators

45 Building a System to Link and Retain Overview: To visually create a system and its sub systems that depict organizational relationships that link patients to care within each region of Queens and Staten Island. The diagrams will illustrate: the strength of organizational relationships (none to strong). linking and retaining patients in care Uses: Over time, identify strengths, weaknesses, and opportunities for improvement (system, sub-systems) peer exchange identifying needs for TA and content and methodology for regional workshops

46 Part 1 30 minutes 1.Each agency writes its name on a circle. If there are several departments within an agency, the department(s) can write its name on each of the designated color circle. 2.Each agency goes up to the flip chart and tapes its circle(s) on the flip chart paper. 3.Draw a blue arrow connecting your agency to those agencies that you have a linkage and retention relationship with, ie, protocols in place, frequent referrals and follow up. An arrow in one direction means the communication is essentially in one direction. An arrow that goes in both directions means there is communication and feedback re patients referred, linked and documented. 4.Draw a green line to those agencies that you have a more informal relationship with and less frequent referrals. 5.If you work with an agency that is not here, add its name to a circle and tape it to the diagram. 6.Write down questions, circumstances that fall outside of these directions.

47 Part 2 20 minutes 1.For those agencies (departments) that you have a blue line, write down your strategies or what you do to refer and link patients to care. 2.For agencies (departments) that provide primary care, write in your circle or next to it, what strategies you use to retain patients in care.

48 Part 3 10 min Large group exchange: 1. Share your experience and observations in creating the diagram. Were there new insights? To what degree was there agreement? 2.What are some of your system s strengths? subsystems strengths? 3.Are there opportunities to strengthen your system? Sub-system? 4.What can you observe about your strategies for linking or retaining patients?

49 Western NYS Rochester Network Diagram

50 Consumer Involvement in NY Links Dan Tietz, NYSDOH AIDS Institute John Anthony Eddie, Staten Island Consumer Representative Kevin Uhrin, Queens Consumer Representative

51 NYS Special Projects of National Significance (SPNS) Systems Linkages and Access to Care Queens/Staten Island Consumer Involvement Presented by: Daniel Tietz Program Manager Consumer Affairs NYSDOH, AIDS Institute

52 Consumer Partners in SPNS Persons Living with HIV/AIDS (PLWHA) Play a unique role in identifying emerging trends in the epidemic to assess unmet needs and to identify effective services Evaluate through a personal lens the feasibility of implementing proposed policies and programs Navigate HIV health care service delivery systems and can inform policy making as they confront gaps in services or barriers

53 PLWHA Roles/Responsibilities Provide formal recommendations on how best to address public health priorities of engagement, linkage, and retention in care for PLWHA to improve health outcomes Develop strategies to communicate/disseminate information about what is transpiring within SPNS.

54 PLWHA Expectations Attend/participate in learning sessions, conference calls, webinars and/or trainings Serve on agency-specific CABs and/or multidisciplinary QI teams/ committees to provide recommendations, from a consumer perspective, on strategies to engage, link and retain PLWHA in care Serve as community ambassadors to communicate the work of the SPNS from the NY State DOH AIDS Institute, NY City DOH and Mental Hygiene, regional groups, local providers, CABs, and the PLWHA community at-large

55 Benefits of Participation Learn quality management principles and terminology Be engaged as partners in quality improvement activities among HIV service providers Participate in a new model of care (through the SNPS initiative and beyond) Develop strategies to keep consumers engaged, linked, and retained in care to improve overall health outcome for PLWHA in Queens/Staten Island.

56 Introductions & Perspectives from Consumer Leads John Anthony Eddie Staten Island Representative Kevin Uhrin Queens Representative

57 Working Lunch Lunch Breakout Sessions a) Introduction to Response Team b) NY Links Measures Q&A

58 NY Links Evaluation Overview and Data Collection Methods Denis Nash, PhD, MPH Diane Addison, MIA, MPH

59 NY Links Evaluation Diane Addison, MPH Denis Nash, PhD, MPH CUNY School of Public Health 60

60 Evaluation Overview

61 NY Links Evaluation Objectives Evaluate the effectiveness of strategies piloted in 4 collaboratives to improve linkage, engagement and retention in HIV care. Identify best-practice strategies for improving linkage and retention Evaluate the impact of dissemination and scale-up of best practice strategies found to be effective at improving outcomes. Participate in and contribute to the multi-state evaluation process. Timeline Years 1 & 2 Evaluate collaborative activities Collect/analyze new and existing data on program outcomes, identify best practices (from the literature & collaborative process) for improving linkage and retention for statewide scale-up. Years 3 & 4 Evaluate impact of statewide scale-up Collect/analyze new and existing data to monitor scale-up of effective linkage 62 and retention strategies across New York State

62 Evaluating the impact of collaborative activities Ongoing measure of outcomes at each site Ongoing measure of strategies (existing and new) Correlate outcomes with implementation of strategies

63 NY Links outcome measures

64 NY Links Site-based Measures Measure Linkage Retention New Patient Retention Clinical Engagement New Client Clinical Engagement Agency Type All Programs that Conduct HIV Testing HIV Clinical Care Supportive Services, General Medical, and Dental 65

65 UMRG Linkage to care: proportion of newly diagnosed clients linked to care within 30 days 74 clients 15/16 sites 72 clients 12/16 sites Data Source: NY Links collaborative measures, updated: January 16,

66 UMRG Retention in care by site, December submission: percentage of patients retained Oct Mar /39 % of patients retained in care Overall 72.2% Data Source: NY Links collaborative measures, updated: January 16,

67 Surveillance-based measures Linkage retention Median CD4 count concurrent AIDS diagnosis Viral load suppression

68 Measuring strategies (existing & new)

69 Existing Strategies: Baseline Evaluation Survey Goal: To systematically characterize NY Links participating sites Areas of focus included: Types of services provided (HIV testing, supportive services, HIV care) # of newly diagnosed clients # of patient/clients accessing clinical care and supportive services Existing strategies aimed at improving linkage and retention Additionally, new strategies or planned enhancements to existing strategies Formal and informal partnerships used to increase linkage and retention Formal partnerships/affiliations may include those in which there is an official memorandum of understanding, contract, or other binding document between your organization and another entity. Informal partnerships/affiliations may include those in which there is NO binding contract or memorandum of understanding between your organization and another entity. You work together casually as members of the same community. 70

70 Existing formal referral partnerships among UMRG testing and HIV primary providers Supportive services/hiv testing providers African Services HIV primary care providers Addiction Research & Treatment Corp. Beth Israel MMTP AIDS Service Center Alianza Dominicana The Iris House Planned Parenthood, NYC Streetwork Uptown Washington Heights Corner Project Center for Comprehensive Health Practice Community Healthcare Network Harlem Hospital Harlem United Heritage Health Care Center Institute for Family Health Lenox Hill Retroviral Disease Center Mt. Sinai Medical Center NY Presbyterian, CUMC St. Luke s Roosevelt Hospital Center Settlement Health & Medical Services Data source: UMRG Baseline Evaluation Survey, updated April 20 th, 2012 Willam F. Ryan Community Health Center

71 New or modified strategies tested: Intervention Strategy Tracking Tool Purpose of Intervention Strategy Tracking Tool: Capture information on new strategies being tested and implemented to increase linkage to and retention in care Connect the testing and implementation of new strategies to the PM data results Develop of a compendium of successful linkage and retention strategies Frequency: Quarterly Domains: -Types of strategies tested -Intended impact of strategies -Populations targeted - Strategy coverage/fidelity -Use of Plan-Do-Study-Act (PDSA) cycles -Challenges/barriers to success -Outcomes 72

72 Example: Interventions/strategies being used by UMRG providers to impact linkage and retention C= HIV clinical care, T= HIV testing, SS=provides supportive services, E=Strategy that Existed prior to start of NY Links, R= Response Team member, P=Strategy in Planning stage, T =Strategy being Tested: start date(m/yy), IM=Strategy is fully Implemented: start date(m/yy) if letter is in lower case (e.g. im, t, p) then site has this strategy in place, but is testing or implementing a modification or addition to the strategy. +=part of care coordination strategy, Target pop=target population of planned, tested or implemented strategy: A=all, MM=methadone maintenance, ND=newly diagnosed, OC=those out of care, MSM=men who have sex w/men, HY=homeless youth, IAPAC=International Association of Physicians in AIDS Care: categories of evidence based linkage and retention recommendations. Data Source: Intervention Strategy Tracking Tool, UMRG updated Jan 30, 2013

73 Example: New system linkages & process/data improvements by UMRG providers C= HIV clinical care, T= HIV testing, SS=provides supportive services, R= Response Team member, Y =yes (name of partner), P=System/process in Planning stage, T=System/process being Tested: start date(m/yy), IM=System/process is fully IMplemented: start date(m/yy) ARTC=Addiction Research & Treatment Corporation, ASC=AIDS Service Center, CCHP= Center for Comprehensive Health practice, CHN=Community Health Network, H. = Health, U. =United, Serv.=Services, IFH=Institute for Family Health, MMTP=Methadone Maintenance &Treatment Program, emerge=emergency, sup=supportive link=linkage, treat=treatment, med=medical, sub=substance, shorten=shortening Data Source: Intervention Strategy Tracking Tool, UMRG updated Jan 30, 2013

74 Correlating outcomes with implementation of strategies

75 Start of Upper Manhattan Regional Group % of clients linked or retained

76 Envisioning a successful Queens and Staten Island collaborative High quality, innovative and impactful interventions are necessary but not sufficient for a successful collaborative. We also will need: Evidence/data to support them and justify their wider dissemination Tools/manuals/protocols for others who want to adapt The quality of the evidence NY Links can generate about interventions ultimately depends on the completeness and quality of the data we generate Information about type and timing of interventions being implemented Information on collaborative measures (outcomes)

77 Thoughts/questions/comments on NY Links Collaborative Evaluation? Diane Addison Denis Nash

78 Constructing NY Links Outcome Measures Using Population-Based HIV/AIDS Surveillance Data Denis Nash, PhD, MPH Rebekkah Robbins, MPH

79 Presented at the AIDS Institute/ NY Links Queens and Staten Island Collaborative Learning Session, February 22, 2013 The New York City Department of Health and Mental Hygiene, th St. Long Island City, NY 11101

80 Presented at the AIDS Institute/ NY Links Queens and Staten Island Collaborative Learning Session, February 22, 2013 The New York City Department of Health and Mental Hygiene, th St. Long Island City, NY among diagnosed PLWH

81 The Upper Manhattan Collaborative Experience Building the Foundation for a Wall of Innovation Small Group Work Lenee Simon, MPH Jenny Knight, Harlem Hospital Center Judy Yan, UM Response Team

82 Building a Wall of Innovations in HIV Care Linkage and Retention Lenee Simon, NY Links, NYCDOHMH

83 Wall of Innovations Activity Exercise to brainstorm improvement strategies and processes to link and retain clients in ongoing HIV primary care Conducted with the NY Links Upper Manhattan Regional Group at the start of their Collaborative Created a symbolic wall by displaying linkage/retention ideas at Learning Sessions Continually build the wall by adding and refining concepts for both internal and crossagency collaboration in linkage and retention

84 Sample of Upper Manhattan Regional Group Early Brainstorming Existing Strategy Develop relationships with housing case manager and supportive services to track patients who have fallen out of care (informal system at this time) Integrated testing models new patients are informed testing is available and offered testing (at least once). High risk clients are offered more frequently and counseled on risk mitigation New Strategy Establish set relationships with housing, cobra, case management support services Using health information technology to improve linkage and retention support using public health data to drive patient retention activities (support bi-directional data sharing; NYS law change-allowing HIV/STD data to be linked

85 From Wall of Innovations to Action UMRG Linkage and Retention Projects 20 Upper Manhattan Regional Group participating agencies at varying levels of planning, testing, or fully implementing linkage and retention strategies Some agencies established new activities while others used an existing project Strategies are being tested across 13 main category headings

86 Interventions/strategies being used by UMRG providers to impact linkage and retention C= HIV clinical care, T= HIV testing, SS=provides supportive services, E=Strategy that Existed prior to start of NY Links, R= Response Team member, P=Strategy in Planning stage, T =Strategy being Tested: start date(m/yy), IM=Strategy is fully Implemented: start date(m/yy) if letter is in lower case (e.g. im, t, p) then site has this strategy in place, but is testing or implementing a modification or addition to the strategy. +=part of care coordination strategy, Target pop=target population of planned, tested or implemented strategy: A=all, MM=methadone maintenance, ND=newly diagnosed, OC=those out of care, MSM=men who have sex w/men, HY=homeless youth

87 Intervention/Strategy Categories Appt. Reminders Systemic Monitoring of Linkage/Retention Care Coordination Case Management Patient Navigation Medication adherence education/counseling Streamlining, standardizing referrals Same day/expedited services Outreach/Follow-up Peer Support Multi-staff/multipronged approach Transitional care coordination Coordinated messaging Other Interventions

88 A sample of UMRG interventions/strategies being tested or implemented Strategy Developing database that contains a registry of HIV + pts. Will be used to identify pts who are out of care. Target populations Those lost to care Testing: New linkage with NYC DOHMH's Harlem STD Clinic, which has begun bringing over persons with positive preliminary HIV tests for confirmatory testing and linkage to care. Newly diagnosed patients Testing: A sample of patients from the Care Coordination program were given client journals to document upcoming appointments, as well as current medications and lab results. All patients Provide the option to clients upon initial preliminary positive test to meet with a provider the same date that they test preliminary positive. Newly diagnosed patients Data Source: Intervention Strategy Tracking Tool, UMRG August 28, 2012

89 A sample of UMRG intervention/strategies being tested or implemented Strategy Link newly diagnosed clients into care with 72 hours, by utilizing a daily testing and referral log. Target populations High risk, but unaware of HIV status/newly diagnosed clients Individual behavioral risk assessments used to detect high risk cases and stratify interventions. Multiple members of the treatment team intervene with the client at different times delivering the same message Patients thought to be at high risk of dropping out of care/ newly diagnosed patients Re-instated Care Coordination outreach to patients who have not had a primary care visit within 9 months. Modified RHIV testing database to capture exact linkage date and RHIV CQI project to include HIPAA capture rate, to verify outside linkage to care. Those lost to care Collaboration to establish a more formal referral/linkage system for individuals testing preliminarily positive. Newly diagnosed patients Data Source: Intervention Strategy Tracking Tool, UMRG August 28, 2012

90 Harlem Hospital Center s NY Links QI Project Jenny Knight, NYC Health and Hospitals Corporation Harlem Hospital Center

91 Intriguing Improvement Strategies In Upper Manhattan Harlem Hospital Center Jenny Knight Systems Linkages and Access to Care for Populations at High Risk for HIV Infection in New York State

92 Harlem Hospital Center Improvement Strategy: We developed an active patient census database that allows us to run Quality Improvement Indicators by provider This improvement strategy allows us to actively involve providers in improving annual indicators such as patient retention, annual exams, pap smears for women and viral suppression

93 Harlem Hospital Center What makes your Strategy Intriguing? The Harlem Hospital Family Center Clinic is working hard to develop proficiency in using data in real time as opposed to depending on data from sometimes outdated annual reviews During the SPNS collaborative we developed the Census. Have successfully updated it, we are now actively using it to improve performance on annual exams, pap smears, viral suppression and patient retention.

94 Retention Rate Submission Dates: Dec 11 Feb 12 Apr 12 June 12 Aug 12 Oct 12 Dec 12

95 % of Patients with Viral Load < 200 copies at last viral load test during the measurement year

96 Harlem Hospital Center Next Steps Next Steps In 2013 we will continue to use the patient census to improve indicators: Patient Retention Improve process for identifying out-of-care patients through census and tracking targeted interventions to bring patients back into care Annual Exams Support patient retention by using Patient Census to identify patients due for annual exam by provider and target outreach efforts to support patients in keeping annual visits Viral Suppression: Run viral suppression by provider quarterly to increase focus on high-risk patients

97 Next Steps: Improving Patient Retention Background: In October, a patient navigator was hired whose job includes linking patients back into care He works with the data manager to keep the patient census up-to-date Currently navigator has census divided by provider and scrolls through each list to find patients not seen in the last 6 months He then implements an outreach protocol of phone calls and letters to bring patients back into care

98 Patient Retention PDSA Plan: Use the Gap measure list of patients generated every two months to identify to current list of patients lost to care, incorporate provider feedback into outreach efforts and track follow up

99 Patient Retention PDSA DO 1. Data Manager forwards list to patient navigator (about 100 names) 2a. Patient Navigator uses census to delete the patients who are either back in care or known not to attend the clinic. 2b. Patient Navigator divides list by provider 3. Each provider receives their list and is asked to provide any updated information about the patient and advice for bringing the patient back into care 4. Based on revised list, with provider input, patient navigator initiates outreach protocol

100 Study Is this a realistic process? How long does it take for the patient navigator to generate this list and get provider feedback? (measurement: # of days it takes to get the final list) Is this a more efficient process? Does the information received from providers cut down on unnecessary outreach effort (measurement: # of initial phone calls saved) Is this process more effective? Are we able to contact more patients lost to care? Are more patients re-engaged in care? Is it easier to track retention efforts and outcome?

101 Act QI team will evaluate initial findings to further refine re-engagement efforts

102 Building a Wall of Innovations in HIV Care: Small Group Work Judy Yan, NYC Health and Hospitals Corporation

103 Building the Foundation: Wall of Innovation Small Group Work Goals: For each provider to identify and acknowledge existing, successful interventions to improve linkage and retention in care that were implemented in the past year. To identify the intervention category that is most appropriate for these successful interventions To place the successful interventions on the Wall of Innovation to serve as the foundation for innovation moving forward

104 Directions Working with your agency team, colleagues or a table facilitator, review your current processes for linkage and retention in care. Select the most successful interventions that your agency has implemented in the past year. You can use this page for brainstorming and notes. After identifying the most successful intervention for linkage to care and the most successful intervention for retention in care, review the UM intervention/wall of Innovation categories and decide which category your intervention matches. If your existing, successful intervention does not fall within any category, label it OTHER. Write a brief description of the interventions on the Post-It notes provided along with your agency name. Also indicate if the intervention improved linkage or retention. Place your Post-Its on the flip chart paper Wall of Innovation in the appropriate category. It s OK if your agency does not have interventions for both linkage and retention.

105 Intervention/Strategies Categories Appt. Reminders Systemic Monitoring of Linkage/Retention Care Coordination Case Management Patient Navigation Medication adherence education/counseling Streamlining, standardizing referrals Same day/expedited services Outreach/Follow-up Peer Support Multi-staff/multipronged approach Transitional care coordination Coordinated messaging Other Interventions

106 NY Links Quality Framework Johanna Buck, RN, MA

107 IHI Adapted Collaborative Model Supports Visits Phone Conferences Monthly Team Reports - Assessments LS = Learning Session AP = Activity Period PDSA = Plan, Do, Study, Act

108 What is Needed to Get the Work Done? Four essential components: 1.QI Collaborative Teams 2.Performance Measurement (data) 3.Testing of Linkage and Retention Improvement Interventions (PDSA S) 4.Consumer Involvement With supports from the NY Links team- visits, conference calls, webinars, workshops

109 Benefits of Teams In Quality The task is complex Creativity is needed Improvement The path forward is unclear More efficient use of resources is required Fast learning is necessary High commitment is desirable The implementation of a plan requires the commitment of others

110 QI Collaborative Team Next Steps Identify a leader who will drive change, support quality improvement activities, direct resources and facilitate communication within the organization in support of the agency specific NY Links activities; Form a multidisciplinary team, including expert staff (data and evaluation, quality improvement, clinical providers, consumer involved in QI) to participate as a team in the Q&SI Collaborative; and Members of the Collaborative Team attend all learning sessions and champion linkage-retention activities in the agency.

111 Performance Measurement NY Links Measures Presentations by Denis Nash, Diane Addison and Rebbekah Robbins

112 Model for Improvement: Applied to Testing Linkage and Retention Interventions The PDSA Cycle

113 The PDSA Cycle for Learning and Improvement The PDSA Cycle

114 The PDSA Cycle (cont.) Test on Small Scale: - formulate question and predict results - conduct test over short time, 1-2 weeks - test first in safe zones (with team members, volunteers) - do not try to get buy-in, consensus, Just-do-it - collect useful just enough data, not perfect data

115 Rationale for Testing Linkage and Retention Interventions Increase your confidence that the change will result in improvement in your organization Learn how to adapt the change to conditions in the local environment Minimize resistance when you move to implementation

116 Consumer Involvement in NY Links Dan Tietz, John Anthony Eddie and Kevin Uhrin Need I say more?

117 Break

118 Queens and Staten Island Collaborative QI Teams Action Planning and Reflection: Small Group Work Johanna Buck, RN, MA Table Facilitators

119 Action Planning Objectives Develop an action plan that reflects the immediate next steps needed to begin the NY Links collaborative activities at your agency in the following areas: QI Collaborative Team Start-Up NY Links Data Submission Preparation Selecting an Intervention to Improve Linkage/Retention Involving Consumers in NY Links Activities Clearly define tasks, timeframes and accountability (what, by when, by whom, how) to implement the action plan

120 Objectives (continued) Identify any other needs (resources, assistance, clarification..) required to begin activities Create a written plan to bring back to colleagues at your agency for feedback, advice, support, approval

121 Small Group Instructions: 40 minutes 1.Locate the Beginning Our Collaborative QI Team Action Planning tool in your packet. 2.Review the resource materials on the right side of your packet and the NY Links Quality Framework slides. 3.Together with your team members, review the tool and resources and compare the Meeting Reflection Notes you ve made throughout the day. 4. Identify at least 3 concrete, immediate next steps in each area to begin the NY Links activities at your agency. 5.There is a table facilitator at each table to answer questions and provide additional explanation if needed. The table facilitator is also available to work with agencies that have only one participant at the meeting.

122 Wrap Up: Summation Steve Sawicki, MHSA Clemens Steinböck, MBA

123 Contact Information Steve Sawicki, SPNS Lead Lenee Simon, Senior Program Manager Johanna Buck, Quality Consultant Annelise Herskowitz, Program Assistant Daniel Tietz, Program Manager Consumer Affairs Clemens Steinböck, Director of Quality Initiatives General information

124 Adjourn! Thank you!