A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

More documents

Recommendations

Info

A Guide to Primary Care of People with HIV/AIDS Chapter 17: Quality Improvement 17 The regular, ongoing work of the QI Committee, supported by the clinic’s leadership, constitutes the backbone of the infrastructure that supports ongoing QI activities. The committee oversees the dynamic process of planning, implementation, and evaluation that involves: • Analysis of data from the QI projects • Solicitation of feedback from participating staff • Decision-making based on the information from its analysis These activities contribute to sustaining the QI Program and its activities in the clinic. Will improvements last? Sustainability is probably the biggest challenge that clinics face in the field of QI. All too often, improvements do not last once initial projects are completed, because the structure and culture to support QI is not present or is not supported. The challenge of sustainability is therefore two-fold – not only to maintain the successes of QI work and its clinical outcomes, but also to maintain the systems of QI and to keep the QI program vital. By asking questions about how care systems can be improved and how QI activities are progressing, clinicians play an important role in both catalyzing and supporting QI activities. What are the key components of a quality plan? The key elements of a quality plan include a quality statement that describes the purpose and goals of the QI program, priorities of the program, a description of the organizational systems needed to implement the program, including committee structure and functions, definitions of accountability, roles and responsibilities, the process for obtaining consumer input, core measures, data collection processes, and a description of how the plan will be evaluated. KEY POINTS Providers play an active role in the activities of QI and can lead these efforts by asking questions to determine how improvements can be made. Although the QI program may require extra work from busy providers, the opportunities to systematically measure clinical performance will provide useful information that leads to better care for the patients they serve. QI includes regular measurement of care processes, analysis of processes and systems of care, and implementation of solutions to improve care and monitor their effectiveness. The goal of QI is to achieve optimal health outcomes for patients. QI teams identify areas of change, implement pilots to test the change, review data assessing the change, and ultimately make recommendations about improvements. When staff members from the systems being assessed work together in teams and are engaged in the QI process, they are more likely to generate ideas and to accept changes. Indicators, measurable aspects of care that evaluate the extent to which a facility provides a certain element of care, should be based on standards or guidelines, meet the primary goals of QI, and reflect priorities specific to the community and the clinic. Once data have been reviewed by the team and the process for improvement identified, the next step is to decide where opportunities for improvement exist. This process is described as the PDSA (Plan- Do-Study-Act) process. The first step is to investigate this care process in greater detail. Once a change in a particular step of the process has been selected, a pilot test of the change can be quickly implemented and evaluated. If the pilot is successful, the change can be adopted widely. If the pilot is not successful, another change can be selected and tested. Sustainability is probably the biggest challenge that clinics face in the field of QI. The key to sustaining QI in the clinic is development of an infrastructure that supports ongoing QI activities. 146 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
A Guide to Primary Care of People with HIV/AIDS Chapter 17: Quality Improvement SUGGESTED RESOURCES AETC National Resource Center and New York State Department of Health AIDS Institute. Measuring Clinical Performance: A Guide for HIV Healthcare Providers. Available at http: //www.hivguidelines.org/public_html/center/ quality-of-care/perform_guide/perform-guideintro.htm Accessed 1/04. Berwick D, Godfrey AB, Roessner J. Curing Health Care. San Francisco: Jossey-Bass; 1990. HIV/AIDS Bureau. Quality Management Technical Assistance Manual. Rockville, MD: Health Resources and Services Administration; 2003. Available at http://hab.hrsa.gov. Institute for Healthcare Improvement. HIV/ AIDS Bureau Collaborations: Improving Care for People Living with HIV/AIDS Disease. Boston: Institute for Healthcare Improvement; 2002. Available at http://www.ihi.org/collaboratives/ breakthroughseries/HIV/ChronicCare.pdf. Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press: 2001. Langley GJ, Nolan KM, Norman CL, Provost LP, Nolan TW. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco: Jossey-Bass; 1996. McGlynn EA, Asch SM. Developing a Clinical Performance Measure. Am J Prev Med. 1998;14(3 Suppl):14-21. New York State Department of Health AIDS Institute. HIVQUAL Group Learning Guide: Interactive Quality Improvement Exercises for HIV Healthcare Providers. http: //www.hivguidelines.org/public_html/center/ quality-of-care/performance_measurement_ materials/glg/group_learning_guide. Scholtes PR, Joiner BL, Streibel BJ. The Team Handbook (3rd Ed). Madison: Oriel, Inc; 2003. WEBSITES* HIV-Specific Examples http://hab.hrsa.gov/special/qualitycare.htm http://hab.hrsa.gov/tools/QM http://www.hivguidelines.org Quality of Care Section. http://www.qualityhealthcare.org/QHC/ Topics/HIVAIDS http://www.ihi.org/collaboratives/ breakthroughseries/hiv http://www.qaproject.org General QI Websites http://www.qualityhealthcare.org/qhc http://www.ihi.org (Institute for Healthcare Improvement) http://www.isqua.org.au (International Society for Quality in Health Care) http://www.asq.org (American Society for Quality) http://www.mytapestry.com (contains many links to other websites) http://www.ahrq.gov (Agency for Healthcare Research and Quality) http://www.jcaho.org (Joint Commission on Accreditation of Healthcare Organizations) http://www.nahq.org (National Association of Healthcare Quality) http://www.musc.edu/fm_ruralclerkship/ (Family Medicine/Rural Clerkship CQI) * Websites accessed 1/04. 17 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau 147
Page 1 and 2:
Edited by John G. Bartlett, MD Laur
Page 3 and 4:
2004 Edition A Guide to Primary Car
Page 5 and 6:
A Guide to Primary Care of People w
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106: A Guide to Primary Care of People w
Page 155: A Guide to Primary Care of People w
Page 180: Use these quick-reference page tabs
show all

A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?