High Priority Initiatives

Organizations are prioritized for intensive technical assistance and quality improvement coaching in two ways. First, organizations with clinics that score at or below the 25th percentile for viral load suppression in the most recent statewide review of HIV care are prioritized. Organizations that do not complete and submit a self-review of HIV care are also prioritized.

These organizations are asked to submit a rolling 12-month viral load suppression (VLS) rate for each clinic that meets this criterium. Quarterly VLS rates are submitted to their assigned QOC program quality coach using the Quality of Care Program High Priority VLS submission template (see below).

The quality coach tailors technical assistance to meet the needs of each organization. This may include reviewing quarterly VLS submission with the organization’s HIV clinical quality management team, or HIV clinical care lead. Coaching sessions may include a discussion of the quality improvement intervention, including quality goals, improvement plans, and PDSA (Plan/Do/Study/Act) small scale tests of change, as well as revisions to QI activities based on PDSA outcomes. The coach may suggest the use of specific quality improvement tools or methods based on issues and challenges shared by the organization. The coach can provide instruction on the purpose and use of these QI tools. The coach also facilitates organizational assessments and provides coaching support and training on the development of strong quality infrastructure.

High priority work is discussed for input at weekly Quality of Care Program Coaches Huddles and monthly Quality of Care Program workgroup meetings. Sharing of the high priority work at coach huddles gives the high priority coach the opportunity to receive input from other coaches. Similarly, the monthly workgroup meetings with healthcare division staff offer the coach additional information that can be used to help support high priority organizations.

The second way that sites are prioritized for high priority coaching involves a collaborative effort with the New York City Department of Health and Mental Hygiene’s Clinical Operations and Technical Assistance (COTA) program. Organizations eligible for this high priority initiative are located in NYC and have a score at or below the 25th percentile of organizations reporting data in the most recent AIDS Institute statewide HIV organizational treatment cascade of care. Other factors considered in the prioritization process include the following:

• Score at or below the 25^th percentile of NYC DOHMH VLS data collected
• Non-submission of NYSDOH QOC Treatment Cascade data
• The organization has a significant portion of patients in its catchment area
• The organization provides care in an area where viral load suppression rates are low
• The organization is not in compliance with grant requirements whether the granter is the NYSDOH/AIDS Institute or the NYCDOHMH
• The organization has not met the NYSDOH/AIDS Institute Quality of Care program standards

For these organizations, an HIV Quality of Care Program Coach works in close collaboration with a COTA technical assistance specialist to provide support through intensive technical assistance and coaching. The QOC coach and COTA TA specialist meet regularly with the high priority organization, reviewing viral load suppression data, QI initiatives and quality management program infrastructure, offering training and assistance as needed. The COTA staff member and QOC coach meet regularly to strategize coaching and technical assistance tailored to meet the needs of these organizations. QOC Program and COTA staff meet monthly to discuss progress with these high priority organizations.