Page 1 of 6 The Michigan Department of Community Health Ryan White Treatment Modernization Act Part D Program Quality Management Plan January 2008 I. Quality Mission: The Michigan Department of Community Health (MDCH) Ryan White Treatment Modernization Act Part D Program goal is to provide comprehensive family-centered health care and support services for women, infants, children, and youth living with HIV and for their affected families in Southeastern, Mid, and Southwest Michigan through a network of services resulting in a seamless continuum of care. Purpose: The purpose of the MDCH CQI program is to reduce barriers to care, reduce health disparities, assure quality of care and improve the health of our patients, and improve the delivery systems and processes. Scope of Services: The Michigan Department of Community Health subcontracts medical, case management, support services, and health education services to providers in Detroit, Oakland County, Genesee County and the eleven county area that constitute the southwest corner of the state. The subcontracted agencies include the Wayne State University-Detroit Medical Center (DMC), AIDS Partnership Michigan (APM), Community AIDS Resource and Education Services (CARES), the Detroit Department of Health and Wellness Promotion (DHWP), Visiting Nurses Association (VNA), and Wellness Services, Inc (Wellenss). II. Quality Infrastructure The infrastructure will consist of the Part D Executive Committee and MDCH Part D administrative staff. The members will be responsible for: Developing priorities, determining aspects of care, and setting quality improvement goals; Use continuous improvement methodologies; Providing research and/or feedback to address problems/concerns to improve overall quality management program; Reviewing and analyzing the results of quality indicators, surveys, and other data collection materials and making pertinent recommendations to the plan; Reviewing the Quality Management plan on an annual basis and makes recommended changes and/or variations, as needed; and Each individual agency/program is responsible for its own Quality Management Plan and is accountable to MDCH Part D to provide data, make improvements on areas of low performance, and share Quality Improvement Plans at Executive Committee meetings. The meetings will be held on a quarterly basis (1 st q-review data and set objectives, 2 nd q and 3 rd -agencies reporting on QI projects, 4 th continued reporting and revising plans)
Page 2 of 6 III. Goals and Objectives: The overall goal of the MDCH Part D Program, through its subcontracted agencies, is to increase the quality of care for our patients and to create a system to monitor continuous improvement. The Detroit Medical Center quality management focuses on the performance of identified HIV clinical health indicators for adult and youth females and children; and the referral and coordination of services among DMC clinics. AIDS Partnership Michigan, Community AIDS Resource and Education Services, Visiting Nurses Association, and Wellness Services, Inc. quality management focuses on the referral and coordination of services for adults and youth clients receiving case management services; and the documentation of a care plan at least every six months. The Detroit Department of Health and Wellness Promotion quality management focuses on linking out-ofcare individuals into Part D care services. Quality Objectives 2006-2007 and 2007-2008 Medical A. Pap smear and pelvic exams (All Titles Indicator) UHC 1. Increase the documentation of pelvic exams from 28% to 75%. 2. Increase the documentation of Pap Smears from 28% to 75%. PIDC 1. Increase the documentation of Pelvic exams from 74% to 99%. 2. Increase the documentation of Pap Smears from 74% to 85%. 3. Increase the documentation of appointments kept for colposcopy from 67% to 95%. Horizons 1. Maintain 100% documentation of pelvic exams and Pap Smears. 2. Increase documentation of referral appointments kept for abnormal pap smears from 78% to 95%. 3. Increase the number of youth returning to care-retention from 85% to 95% B. CD4 count and viral loads (All Titles Indicator) CHM 1. 80% of children receiving antiretroviral treatment will maintain a viral load < 1,000 copies per/ml. UHC 1. 65% of clients will have a CD4 count and viral load at least every six months. PIDC 1. 65% of clients will have a CD4 count and viral load at least every six months. Horizons 1. 65% of clients will have a CD4 count and viral load at least every six months.
Page 3 of 6 Coordination of Services A. Increase interagency collaboration in increased documentation of referrals and referrals made and if client kept the appointment UHC 1. Increase from 51% to 75% the number of Part D eligible client charts which document the coordination of services among two disciplines. Case Management (All Titles Indicator) A. Care (Service) Plan Documentation Horizons-Case management 1. Maintain 100% documentation in client charts which contain a completed service plan, specific goals, documentation of progress toward the goals, service needs, appropriate referrals made, and services will be provided within 6 months of intake. APM-Case management 1. Increase from 84% to (90%) 95% the number of client charts which contain a completed service plan, specific goals, documentation of progress toward the goals, service needs, appropriate referrals made, and services will be provided within 6 months of intake. CARES 1. 90% of clients will have a case management care plan documented and updated at least every six months. VNA 1. 90% of clients will have a case management care plan documented and updated at least every six months. Wellness 1. 90% of clients will have a case management care plan documented and updated at least every six months. Linkages to Services A. Increase HIV testing and referrals of HIV positive women by the Part D Health Educator. 1. 90% of female clients newly diagnosed with HIV will be linked to medical care. 2. 75% of female clients newly diagnosed with HIV and eligible for DMC services will be linked to their Adult HIV/AIDS Program. IV. Quality Indicators Quality indicators will be chosen for review from the following areas: Clinical/medical primary care Coordination of services Case management Outreach/peer support/advocacy Continuity of care Psycho social and mental health services
Page 4 of 6 Major Function/Performance Indicator Data Collection Performance Measure Method Clinical Care 75% of eligible female patients will have documented test results and/or copies from an outside provider (# of women annual Paps smears/ # of women with 1 medical visit in the 12 mo period) Eligible female will have documentation of annual Pap smear/pelvic exams, unless medically contraindicated (Statewide Indicator) Clinical Care Documentation of viral load counts <1000 copies per/ml. for children Clinical care Documentation of CD4 counts and viral loads for adolescent and adult patients (Statewide Indicator) Coordination of Services Clients with identified needs will have documentation of referrals (Consistent with MDCH standards of care for medical case management) Case Management Documentation of case management care (service) plans (Statewide Indicator) Linking to Services Female clients identified as out of care will be linked to medical services. 80% of children will have documented viral load counts <1000 copies per/ml. (# of children with vl counts <1000 copies per/ml./ #of total number of children with documented vl) 65% of clients will have documented CD4 and viral load laboratory test at least twice annually (# of clients with CD4 and viral loads every six months/ #of total number of clients that are seen within the calendar year.) 75% of charts will have documentation of client referrals (# of charts documenting referrals/# of clients with identified needs) 90% of clients will have a care plan documented and updated at least every six months. (# of clients that have a care plan and/or updated in the medical records at least twice in the calendar year of interest/ # of clients who were seen within the calendar year of interest.) 90% of female clients newly diagnosed with HIV will be linked to medical care. (# of newly diagnosed female clients referred and successfully linked to medical care/# of newly diagnosed female clients provided secondary prevention services.) Review of client records. Indicators on psychosocial/mental health, continuity of care, advocacy and outreach will be considered for 2008-2009. Reported through URS/CARE Ware system for each client receiving services from a Ryan White CARE funded provider. Improvement Plan Programs are responsible for developing Quality Improvement Plans if the performance measure is not being met. Programs are responsible for reporting on quality indicators at quarterly Part D Quality Management Committee meetings. MDCH will provide technical assistance if the outcome objective is not met.
Page 5 of 6 V. Implementation Timeline: Year one 2006-2007: Clinical care, coordination of services, and case management. Year two 2007-2008: Clinical care, coordination of services, case management, and linkage to care. Year three: 2008-2009: Possible additional indicators include: Psychosocial and mental health services, continuity of care, and advocacy/outreach. VI. Assessment and Evaluation: Annually, the Quality Management Plan will be evaluated by the Part D Executive Committee. Regular feedback regarding overall quality improvement is critical in sustaining improvements over time. The overall quality improvement goals, objectives, and project plans will be assessed and evaluated to determine if changes need to be made to improve and enhance performance in order to reach optimal care for clients. Based on the review, priorities will be set and opportunities for improvement will be identified. If improvement areas have been identified, a quality improvement project plan will be formulated and the program will be given six months to make changes. The program will report progress to the Executive Committee and the Part D Administrative staff will re-evaluate the plan to determine if appropriate changes have been made. A key component that will be developed and monitored by the Executive Committee will be Quality Improvement plans. The improvement plans will be developed for the clinical primary care, case management, and advocacy portions of the program. The improvements may include clinical guidelines revisions, increased staff education, policy and procedure revisions, and overall system redesign. There will be an annual organization assessment completed and compared to previous years. Part D Program Coordinator Date Medical/Agency Director Date
Page 6 of 6 MDCH Ryan White Part D Quality Management System Part D MDCH Program Coordinator Ryan White Cross Part Quality Committee Part D Executive Committee Quality Mgmt Committee Members & Representatives from Funded Agencies (Meets Quarterly) Part D Sub-Contractor Quality Mgmt Meetings/Trainings DMC APM VNA Wellness DHWP CARES Horizons UHC PIDC CHM Care Services Monthly Team Meetings Monthly Quality Committee Meeting Weekly Case Mgt Mtgs Quarterly Quality Mgt Team Meetings Quarterly Evaluation Mtg Bi-Monthly Mgmt Team Mtgs Quarterly QM Committee Mtg QI Group Project Challenge Monthly Team Meetings, Includes QI Immunology Clinic Bi-Monthly Mgmt Team Mtgs Monthly Mgmt Team Mtgs Bi-Monthly Case Mgr Mtgs **All subcontracted agencies minimally participate in contractual Quality Improvement activities.