stop hiv/aids collaborative & quality improvement network -day 1-workshop 2 - provincial... ·...
TRANSCRIPT
-
Page 1
STOP HIV/AIDS Collaborative & Quality Improvement Network Dr. Rolando Barrios
Assistant Director BC Centre for Excellence in HIV/AIDS
Christina Clarke Quality Improvement Advisor Impact BC
-
Page 2
1. Describe an improvement approach to facilitate change and improve patient care and outcomes
2. Understand the collective impact of the Collaborative on systems and patient outcomes
3. Locate additional resources based on interests
Objectives
-
Page 3
What do you know already about the Collaborative or HIV Quality
Improvement Network?
-
Page 4
What we knew when we began
-
Page 5
1. Treatment is good for the individual, the population and saves the system money.
-
Page 6
2. Effective chronic disease management produces better patient care and outcomes
The Chronic Care model:
Prepared practice teams interacting with informed, activated patients through continuous healing relationships supported by the ongoing availability of health information.
-
Page 7
3. Great ideas and best-practices were isolated in areas throughout BC; we needed to spread this
around
-
Page 8
4. The diffusion and adoption of best-practices doesn’t occur spontaneously; it requires effort and
support
What we know
What we do
-
Page 9
What we do
The STOP HIV/AIDS Collaborative began to close the gap between what we know and
what we do
What we know
-
Page 10
Collaborative methodology
A structure for learning and action that aligns healthcare providers in a common aim and
shared measurement system to make incremental system-level changes to increase
access and uptake of effective HIV care and treatment.
-
Page 11
The Collaborative Model
Participants
P
S
A D
P
S
A D
P
S
A D Closing
Congress Launch LS1 LS2 LS3
Prep AP2 AP3 AP4
Monthly Teleconference Calls Website
Webinars
Electronic Mailing list Messages
Faculty Discussion Forum Site Visits
Action Period Supports
Leadership Committee
Select Topic
Expert Committee
Create change package,
charter, etc.
13 Months
Holding Gains
Adapted from the Breakthrough Series Model, Institute for Healthcare Improvement
-
Page 12
What are we trying to accomplish?
Shared aim:
• Improve retention in care
• Improve HIV care and services
• Strengthen partnerships in care
-
Page 13
How will we know that a change is an improvement?
Shared Measurement:
1. Date of last primary care visit
2. HIV Viral Load
3. ART uptake
4. Virologic control
5. Patient experience with care
-
Page 14
What changes can we make that will lead to an improvement?
Incremental system-level changes using ideas from different sources:
• Clinical guidelines
• Chronic care model
• Patient insights
• Expert ideas
• Colleagues
-
Page 15
The Collaborative Model
Participants
P
S
A D
P
S
A D
P
S
A D Closing
Congress Launch LS1 LS2 LS3
Prep AP2 AP3 AP4
Monthly Teleconference Calls Website
Webinars
Electronic Mailing list Messages
Faculty Discussion Forum Site Visits
Action Period Supports
Leadership Committee
Select Topic
Expert Committee
Create change package,
charter, etc.
13 Months
Holding Gains
Adapted from the Breakthrough Series Model, Institute for Healthcare Improvement
-
Page 16
• Interior • Outreach Urban Health (Kelowna)
• Island • Nanaimo • North Island Liver Services (Courtenay) • Port Alberni • Victoria
• North • Central Interior Native Health Society (Prince
George) • Smithers
• Vancouver area • BC Women’s Hospital/Oak Tree Clinic • Immunodeficiency Clinic • Dr. Peter Centre • DCHC & MAT • Three Bridges • Pender Clinic • Primary Outreach Services • Portland Hotel Society • Raven Song • Vancouver Native Health Society
-
Page 17
The Collaborative Model
Participants
P
S
A D
P
S
A D
P
S
A D Closing
Congress LS1 Launch LS2 LS3
Prep AP2 AP3 AP4
Monthly Teleconference Calls Website
Webinars
Electronic Mailing list Messages
Faculty Discussion Forum Site Visits
Action Period Supports
Leadership Committee
Select Topic
Expert Committee
Create change package,
charter, etc.
13 Months
Holding Gains
-
Page 18
Learning Sessions Teams come together in face-to-face meetings to engage in learning, sharing, and action planning.
-
Page 19
In between Learning Sessions
Testing and measurement
-
Page 20
PDSA cycles (Plan, Do, Study, Act)
Similar to the scientific method only faster. Start with
a prediction (Plan), carry out the test (Do), analyze
what you’ve learned (Study), and then decide
whether you will adapt, adopt or abandon your
change (Act).
-
Page 21
We also measure. Purpose of measurement:
Solberg et al The Three Faces of Performance Measurement:
Improvement, Accountability and Research. Journal on Quality
Improvement, Volume 23, Number 3, March, 1997.
Research
Improvement
Accountability/evaluation
-
Comparing types of measures
Improvement Accountability Research
Aim Improve care
Comparison, choice,
reassurance, spur change
New knowledge
Timeline Often very brief,
weeks to months
Varies Often takes
years
Test Observability
Test observable Test observable
or no test Test may be
blinded
Bias Accept
consistent bias
Measure and adjust to reduce
bias
Design to eliminate bias
-
Improvement Accountability Research
Sample size
“Just enough” data--work into routine, low or no budget
Obtain all relevant available data.
“Just in case”
data.
Major budget expense.
Hypothesis
Flexible, change as learn, part of work process
May not be a hypothesis
Fixed hypothesis
Testing strategy Sequential tests One test or no
test One large test
Confidentiality of data
Data used by improvers only
Data available to public
Protected data and restricted access
Who measures? Improvers External Highly skilled
external team
-
Page 24
On January 31st 2012 the Collaborative transitioned into the HIV Quality Improvement
Network
-
Page 25
Increasing peer leadership & focus on sustainability with support and direction from the Response Team
-
Page 26
What we observed from this Collaboration:
•
•
•
•
•
-
Page 27
67%
74%
87% 90%
90%
92%
91% 92% 90% 91% 90%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Fig 1. Proportion engaged in care
67% 73%
86%
89% 88% 90% 90%
88% 84% 86% 84%
40%
50%
60%
70%
80%
90%
100%
Fig 2. HIV primary care visit every 4 months
84% 82%
76%
86% 88% 87%
81% 84%
86% 85%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Fig 3. HIV plasma viral load test every 4 months
91% 90%
92%
96%
94%
96% 96%
95%
96% 96%
85%
87%
89%
91%
93%
95%
97%
99%
Fig 4. ART uptake among unequivocally in need4
-
Page 28
0%
20%
40%
60%
80%
100%
Fig 6. Proportion of teams collecting and using patient feedback
93%
91%
92%
94%
92%
91%
93%
94% 94% 93% 92%
85%
87%
89%
91%
93%
95%
97%
99%
Fig 5. Maximal virologic control
-
Page 29
•Government of British Columbia
•STOP HIV/AIDS Leadership Committee
•Collaborative Planning Group
•Interior Health
•Northern Health
•Provincial Health Services Authority
•Providence Health Care
•Response Team (Bethina
Abrahams, Misty Bath, Janice Jespersen, Paul Kerston, Sam Milligan, and Ashnoor Nagji)
•Vancouver Coastal Health
•Vancouver Island Health Authority
Acknowledgements
-
Page 30
Thank you! More information at stophivaids.ca or
contact [email protected] or
mailto:[email protected]:[email protected]