Missoula CityCounty Health Department Partnership Health Center Missoula

Missoula City-County Health Department/ Partnership Health Center Missoula, MT Erin Chambers (406) 258 -4184 National Quality Center

HIV in Montana

Clinic Overview • CHC model: – ambulatory medical/dental services with onsite pharmacy. • Services offered: – medical, dental, pharmacy (non-ADAP), limited onsite mental health • 141 RW patients in the 16 counties of the western region • Demographics: – 83% MSM, 14% women 3% heterosexual men, – 84% Caucasian, 6% Native American, 1% African American, 4% Latino, 4% were more than one race, 1% unknown. – Staffing: • Temporary dedicated Continuous Quality Improvement (CQI) coordinator, program coordinator, part-time program assistant

Creating the Quality Management Plan • Three year Capacity Building Grant received for Continuous Quality Improvement (CQI) Program in August 2004 • CQI Program Designer hired November 2004 • Work plan was created using HRSA’s Quality Management Technical Assistance Manual • QM Plan was created primarily from work plan: – “How can we make this work plan happen? ”

Creating the QM Plan , Continued • QM Plan approved by PHC internal Performance Improvement (PI) Committee • Approved by State Consortia – Includes Eastern MT Ryan White program; State ADAP coordinator; case managers – Revision process ongoing yearly • Consumer feedback was solicited on the plan via Consumer Advisory Board (CAB) meeting. • National Quality Center QM Plan Checklist helpful in evaluating plan

QM Plan Structure • Quality Statement – “The purpose of the Ryan White Quality Improvement program is to systematically monitor, evaluate and continuously improve the quality and appropriateness of HIV care and services provided to all Ryan White Title III patients in western Montana. ” • Quality Infrastructure – PHC Performance Improvement Committee Structure: • Quarterly meetings with organization-wide participation including executive director, medical director, and clinic director – Regional CQI Team consisting of case managers in outlying areas – CQI coordinator is responsible for organizing Ryan White quality improvement interventions • When the temporary CQI coordinator position has ended, the RW program coordinator will have this responsibility, in collaboration with the case managers at active contracted sites.

QM Plan Structure, Continued • Quality Plan Implementation – Quarterly chart audits and reports; yearly HIVQUAL data submission – Tracking tools for selected indicators – CQI coordinator on staff until August 2007 per Capacity Building Grant • Third year of Capacity Building Grant is focused on creating a CQI program that is sustainable in the absence of a dedicated staff person, as well as sharing all tools and protocols with eastern Montana. • Performance Measurement – Quarterly chart audits and reports; yearly HIVQUAL data submission – Office of Performance Review process underway May 2005 -May 2008. • Annual Quality Goals – Current annual quantitative goals for selected indicators: • GYN exams for female patients: increase from 89% to 95% • Hep C screening: increase from 83% to 90% • Annual dental visits: increase from 39% to 59%

QM Plan Structure, Continued • Participation of Stakeholders – Specific guidelines for consumer involvement – Representation on PHC Performance Improvement Committee from all departments involved with QI: • Pharmacy, Clinic, Dental, medical director, clinic director, executive director, medical records, diabetes collaborative coordinator, Ryan White • Evaluation – QM program will be evaluated annually to assess quality infrastructure and activities and ensure that the quality program is in line with its overall purpose. Based on those findings, the CQI Team will refine strategies for the following year. Chart audit results, staff and patient comments, effectiveness of QI activities, and program goals will be used to evaluate the program.

QM Plan Structure, Continued • Capacity Building – QM program is shared with outlying areas and with eastern Montana’s Ryan White program • Process to Update QM Plan – Plan is reviewed and updated annually by Statewide consortia – Plan is reviewed annually by internal PI committee • Communication – Bi-monthly CQI email updates and print newsletters – Quarterly Consortia conference calls with CQI Team – Yearly face-to-face Statewide meetings with stakeholders – Quarterly Performance Improvement Committee meetings – Quarterly Consumer Advisory Board meetings

Conclusions • QM Plan is always a work in progress • Feedback from different levels of organization is useful – Clinical staff – Administrative support • Flexibility in how plan is viewed – Utility is more important than format • HIVQUAL technical assistance is incredibly helpful in creating plan

Contact Information Erin Chambers, CQI Coordinator (406) 258 -4184 chamberse@phc. missoula. mt. us