The Quality Management Program at the François-Xavier Bagnoud (FXB) Center, School of Nursing, Rutgers, The State University of New Jersey (NJ), plays a unique role in assuring quality care for patients with HIV. We work in collaboration with agencies throughout NJ at both the local and state levels. Quality Management (QM) chart reviews and technical assistance are provided to the Newark Eligible Metropolitan Areas (EMA) Ryan White (RW) Part A grantees and NJ Department of Health, RW Part B agencies providing Primary Medical Care, Case Management and Dental care. Our staff includes a medical social worker, nurses, and a program development specialist. The audit criteria parameters are defined by the HRSA HIV/AIDS Bureau performance measures guidelines, local (Newark) EMA indicators and indicators based upon the state’s needs, which can be found here.
The goal of our program is to bring together RW care providers to evaluate documented quality indicators and assist them in improving their performance quality when needed. Medical Case Management (MCM) QM has expanded throughout NJ. The guidelines for MCM performance measures can be found here. Examples of performance measures include specific laboratory tests, cervical Pap screenings, and oral health assessments.
Our work includes:
- Comprehensive MCM Training is offered to all of the Medical Case Managers in the Newark EMA. Every year the training is tailored to lessons learned from the aggregate data gained from the chart review.
- Quarterly Steering Committee Meetings for the RW Part B Network, which provide continuous feedback of audit findings and reports. This leads to the discussion of barriers to achieving better quality indicator outcomes among the providers. They are able to collaborate, discuss best practices and share ideas for overcoming these challenges and barriers.
Work Outcomes:
- To improve patient access to dental care and increase oral health assessment performance measures, we implemented Dental QM for all Part B sites. Oral health needs to be an integral part of primary health care of all our patients with HIV. We have noted that Sites where patients have easier access to dental providers appear to have better outcomes for oral health assessments. We have been working closely with Rutgers School of Dental Medicine to educate ourselves on the dentist’s role in the care of the HIV-infected patient. We have established a QM Dental Data Collection Tool to use at our site audits to ensure that the patients are receiving the best oral health care. The guidelines for Oral Health performance measures can be found here. It is our hope that with an increased knowledge of Dental QM, a model of care can be established for increasing patients’ oral health care.
- In response to findings that clinics in our region were not meeting cervical Pap screening performance measures, the NY/NJ AETC developed a free training program - Cervical Cancer Screening in HIV-Infected Women: Pap Smears and Pelvic Examination - to educate Ryan White providers about performing pap smears and pelvic examinations in HIV-infected women.
- We are piloting a new clinical quality measure data collection tool that includes preconception care for women. We’re hoping this additional tool will help RW providers to increase their comfort level with starting the conversation about reproductive options and family planning care with HIV-infected women.
PRECONCEPTION CARE (Female Patients Only) 25. Is the patient newly enrolled in care during last six months of the year? Yes No 26. Was the patient pregnant during the past 12 months? Yes No 27. Was her pregnancy intention documented? Yes No 28. Does she desire pregnancy? Yes No Not documented 28 a. If yes, was she referred for a reproductive health evaluation? Yes No 28 b. If no, does she have a documented method of contraception? Yes No 28 c. Is her method of contraception exclusively condoms? Yes No Not documented |
Since working with the Part B agencies, we have noted improvement in the following areas:
- Hepatitis C screening improved from 83% to 97%.
- Hepatitis B Screening improved from 82% to 95%.
- Oral health assessments by a dentist improved from 32% to 47%.
- Substance abuse screening and mental health screening are both now in the 90th percentile.
QM is constantly changing, and through technical assistance and enabling practitioners to use RW Networks as a platform for discussions, we try to stay up-to-date with all of the best practices and ways to overcome any barriers to care. We have found through our data collection and conversations with providers that multidisciplinary healthcare allows for the best overall health for our NJ patients.
