Quality of Care Program Components

The AIDS Institute Office of the Medical Director convenes advisory committees of stakeholders to promote, monitor, and support the quality of HIV clinical services for persons living with HIV in New York State. The following committees have been established to provide expertise and guidance to the Quality of Care Program.

Quality Advisory Committee

The Quality Advisory Committee provides the AIDS Institute with expert advice regarding the development and implementation of the Quality of Care Program. Since 1992, the Committee has met quarterly and is composed of clinicians who represent HIV medical care clinics from all regions of the state, including Designated AIDS Centers, community health centers, and drug treatment centers. Clinicians with expertise in management of sexually transmitted infections (STIs) and hepatitis are also members, along with leaders of Ryan White Part A service programs and the Department of Corrections and Community Services (DOCCS).

Mission:

To provide expert advice to the AIDS Institute in the development and implementation of the New York State HIV Quality of Care Program.

Background:

The NYS HIV Quality of Care Advisory Committee (QAC) has been active since 1992. The Committee meets quarterly, and is currently composed of clinical representatives from Designated AIDS Centers, Health and Hospitals facilities, Special Needs Plans (SNPs), community health centers, and drug treatment programs throughout New York State. Committee members represent a variety of clinical disciplines, and include nurse practitioners, clinical pharmacists, physicians, social workers, and program administrators.

Scope of Work:

The Advisory Committee identifies priorities for evaluating the quality of HIV care and considers proposed quality indicators. The committee also recommends refinements to existing HIV care indicators as well as development of review criteria. Further, the committee reviews annual performance measurement results to recommend priority areas of focus for the State. Previous QAC work has considered retention in care, use of electronic health records and regional health information organizations to improve patient care, measuring patient mortality as a quality outcome, visualizing performance data, and the integration of STI and HIV services. Recent Committee Activities:

• Consultation in the development of measures to monitor stigma reduction and tobacco cessation efforts in New York State healthcare facilities.
• Consultation in the development and routine use of an adapted CoDe tool to investigate HIV-related mortality and identify strategies to address preventable causes of death among PLHIV.
• Consultation in the development of guidance for organizational HIV treatment cascades, a new initiative that aims to promote health facilities’ use of routinely collected data to track care outcomes of PLHIV who receive services both within and outside the formal auspices of their HIV programs.
• Collaboration with NYS DOH Office of Health Insurance Programs to provide input on Value-Based Payment measures.

Relationship with Consumer Advisory Committee:

In 2002, the AIDS Institute officially established the New York State Consumer Advisory Committee (CAC). The CAC is comprised of at least two members from each region of NYS to ensure representation and communication. Together, the CAC and QAC form a uniquely generative relationship, with each committee providing perspective and insight into quality of care and indicator development. The close relationship between the two committees challenges the patient-provider dichotomy that often hinders quality of care discussions. Co-chairs attend the meetings which have overlapping agenda items and set aside time for updates from the partner committee. Members of both committees are welcome to attend and participate in the meetings of the other. Joint meetings of the CAC, YACAC and QAC were held in September 2014 and 2015 and December 2017.

Recommendations from these meetings critically informed significant NYSDOH AI initiatives including, but not limited to the following:

• The alignment of the NYS quality of care program with Governor Andrew Cuomo’s “Ending the Epidemic” (ETE) initiative and improvement of the ETE Dashboard
• The implementation of a statewide survey measuring barriers to medication access for PLWHA and the submission of related strategies for more effective implementation of ETE Blueprint recommendations, which were accepted by the New York State AIDS Advisory Council in November 2016.
• The development of tools to measure and address HIV related stigma in all healthcare facilities participating in the NYS HIV quality of care program
• Dissemination of Deaf/Hard of Hearing (DHOH) survey and development of pilot virtual peer DHOH HIV testing services.
• The revision of statewide quality indicators to improve the quality of STI care in NYS

Consumer Advisory Committee

Input from persons living with HIV is an integral component of New York State’s Quality of Care Program. The Consumer Advisory Committee (CAC) was established in 2002, and its members represent the diversity of people living with HIV in New York State in terms of geography, gender, race, ethnicity, disability status, socioeconomic status, and exposure category. At quarterly meetings, CAC participants discuss regional quality of care issues from a consumer perspective and consider strategies that can effectively empower relationships with providers. To address the particular needs of young people living with HIV/AIDS and to gain their input, the CAC helped to establish the Young Adult Consumer Advisory Committee in 2008.

Mission:

To provide consumer input to the HIV Quality of Care Program.

Background:

The Consumer Advisory Committee (CAC) has been active and holding quarterly meetings since 2002. Committee members represent the diversity of the AIDS epidemic in NYS in terms of geography, age, gender, race, ethnicity, disability status, socio-economic status and exposure category. The CAC has at least two representatives from each region of NYS to ensure representation and communication. In 2008, the adult Consumer Advisory Committee recommended the establishment of a Young Adult Consumer Advisory Committee (YACAC) to address the needs and gain input from young people living with HIV. In the interest of strengthening ties between the two vulnerable populations of HIV positive youth and older adults living with the virus, the YACAC merged with the larger CAC to form the CAC/YACAC in 2016.

Scope of Work:

The CAC/YACAC advises, from the consumer experience, the NYS DOH on policy matters related to the New York State HIV Quality of Care Program. Key committee activities include identifying issues affecting the quality of HIV care, advising on quality indicators, identifying issues for statewide improvement initiatives, and reviewing clinical guidelines and educational materials. Committee members communicate the work of CAC/YACAC back to their regions and report on regional issues to the statewide committee.

Relationship with QAC:

The Consumer Advisory Committee/YACAC works in close partnership with the NYS HIV Clinical Quality of Care Advisory Committee (QAC), which advises Quality of Care Program. Co-chairs and other members attend respective meetings to ensure transparency and overlapping of agenda items including updates from both committees. Joint meetings of the CAC, YACAC and QAC were held in September 2014 and 2015 and December 2017.

Recommendations from these meetings critically informed significant NYSDOH AI initiatives including, but not limited to the following:

• The alignment of the NYS quality of care program with Governor Andrew Cuomo’s “Ending the Epidemic” (ETE) initiative and improvement of the ETE Dashboard
• Submissions of Treatment Cascades and Quality Improvement Plans among healthcare facilities across New York State
• The development of tools to measure and address HIV/AIDS related stigma in all healthcare facilities participating in the NYS HIV quality of care program
• Dissemination of Deaf/Hard of Hearing (DHOH) survey and development of pilot virtual peer DHOH HIV testing services.
• Formation of subcommittees to address patient reported experience/outcome measures (PREMS/PROMS) and Drug User Health.
• The revision of statewide quality indicators to improve the quality of STI care in NYS

NYC/Tri-County Part A Quality Management Program

Beginning in 2000, the AIDS Institute and the New York City Department of Health and Mental Hygiene established a partnership to provide quality management services to Part A–funded programs in the New York Eligible Metropolitan Area (EMA), which includes New York City and Tri-county (Westchester, Rockland and Putnam counties). Mutual program goals are to improve the quality of supportive services, strengthen provider infrastructure, and to facilitate improvement activities at every stage along the HIV care continuum. The Part A QM Program promotes targeted coaching and support to assist providers as needed in identifying quality infrastructure needs, and provides guidance as needed in developing QI projects and in selecting and testing changes, with the overarching goal to support and sustain quality efforts in Part A programs by building service provider capacity. The program uses QI consultants who demonstrate their expertise by working with programs to apply QI tools and methodologies.. The QM program assists partners in the Care and Treatment program to promote health equity and more integrated QM activities.

ADAP Quality Management Program

In New York State, over 24,000 people each year have access to lifesaving HIV medications through the AIDS Drug Assistance Program (ADAP). New York State employs a comprehensive prospective and retrospective approach to clinical quality management, including quarterly reviews of individual and pharmacy filling patterns to determine medically inappropriate or insufficient regimens. Interventions are initiated with providers to improve patient safety and to modify regimens as required. Data collection strategies include using pharmacy and primary care claims data to assess appropriateness of care.

Quality of Care Workgroup

The Quality of Care Workgroup comprises staff from all programs within the AIDS Institute .stakeholders. Meeting monthly, the workgroup discusses and reviews all Quality of Care Program activities and results, identifying opportunities for improvement and for increased capacity building among New York State HIV providers. Areas of focus include the development of processes to assist low-performing clinics in improving the quality of care that they provide, developing and refining the Quality of Care Standards, engendering peer learning opportunities through quality learning network activities, and developing and refining quality of care campaigns and special initiatives.