HIV Cross-Part Care Continuum Collaborative (H4C) Pre-Work Manual

HIV Cross-Part Care Continuum Collaborative (H4C) Pre-Work Manual National Quality Center November 2013

TABLE OF CONTENTS A) PRE-WORK ASSIGNMENTS 3 B) CROSS-PART COLLABORATIVE OVERVIEW 5 C) H4C BACKGROUND 8 D) RESOURCE SECTION 18 E) GLOSSARY OF IMPROVEMENT TERMS AND CONCEPTS 26 F) FACULTY AND COACH CONTACT INFORMATION 29 H4C Pre-Work Manual November 22 nd, 2013 Page 2 of 29

A) PRE-WORK ASSIGNMENTS The following activities need to be completed by each participating state as pre-work assignments: 1. Formalize State Team 2. Select a Response Team 3. Draft State Aim Statement for H4C 4. Complete the Health IT Assessment Survey 5. Create Story Board for Learning Session 1 6. Submit Inventory of HIV Care Continuum Improvement Initiatives and Strategies 7. Join GlassCubes for H4C Participants 8. Build Excitement and Commitment within your State to Participate in this Initiative The various due dates for the components are listed in the time table at the end of this section, as well as the party responsible for submission. All documents should be submitted electronically to GlassCubes and should be brought in hardcopy to the first Learning Session, occurring January 22-23, 2014. If your state needs any help with pre-work, H4C coaches, H4C staff, or HAB staff are available to assist you. In addition, a pre-work webinar will be held on Thursday, December 5, 2013 at 11am ET. The webinar is accessible by dialing 866.394.2346 and using participant code 397 154 6368 #. The webinar URL is http://www.nqcqualityacademy.org/h4c. 1) Formalize State Team NQC has drafted a letter of commitment your state team may use to express its commitment to H4C. As an attachment to the letter, a roster of agencies signing on to H4C should be provided in addition to the names, phone numbers and email addresses of the individuals that will represent the agency during state team meetings. This list will also identify the agency representatives on your State Team and their proposed roles. Each State Team is asked to identify a name for its team that best represents the spirit and aspirations for this improvement collaborative. This letter and its attachment should be submitted by Friday, December 27 th. 2) Select a Response Team Representatives from each state form the Response Team the group that provides leadership for the State Team and represents the State Team in the face-to-face H4C Learning Sessions. Each state needs to identify its representatives and their various roles and responsibilities on the Response Team and report them to the H4C Faculty. Your H4C coach can help you think through considerations for the Response Team. The H4C Faculty hopes that each Response Team meets at least once before the first Learning Session in Washington, DC on January 22-23, 2014. Members from the Response Team will be expected to attend this Learning Session to represent your state; NQC will financially support a core group from each state to attend. A list of the Response Team members and roles should be submitted by Friday, December 27 th. 3) Draft State Aim Statement for H4C An Aim Statement is an explicit statement summarizing what your state plans to achieve during H4C and outlines the concrete goals and objectives for participation in this 18-month initiative. The assigned coach is available to provide feedback and input. See the Resources section for more information regarding the Aim Statement, as well as examples. This Aim Statement should be completed in time for the first Learning Session, January 22-23, 2014. 4) Complete Health IT Assessment Survey Ryan White grantees of record will be asked to complete the Health IT Assessment Survey. For network lead agencies, the option is available to forward the survey to subgrantees. A survey should still be H4C Pre-Work Manual November 22 nd, 2013 Page 3 of 29

completed for the entire network by the grantee of record. This survey requires familiarity with the H4C Performance Measures, so you will need to review these prior to taking the survey. The details of these measures will be attached to the email containing the survey link and will be available on GlassCubes and the NQC website. This survey is available at https://www.surveymonkey.com/s/h4cprework and should be completed by Friday, December 27 th. 5) Create Story Board for Learning Session 1 Each state is asked to develop a Story Board to introduce your state team to the other state teams at the first face-to-face learning session in January 2014; use your creativity and collective wisdom. The Story Board is an opportunity to have some fun and show the unique character of your state and the HIV provider organizations in it. NQC will provide a template; note that the Story Board template is in PowerPoint, but a physical version of the Story Board should be printed for presentation at the first Learning Session. The Story Boards can take many forms, where it is a collection of 1 page printed PowerPoint slides, a poster board, an infographic, or some other visual way of displaying the designated information feel free to be creative. See the PowerPoint template for Story Boards attachment for more in-depth information on preparing your Story Board for the first Learning Session, January 22-23, 2014. 6) Submit Inventory of HIV Care Continuum Improvement Initiatives and Strategies Many groups have been working on points along the Care Continuum for many years, especially focusing on retention and viral load suppression. An important first step for state teams to take is to gain a full understanding of what has been attempted across the state over the years and what has proven to be more and less successful in impacting performance. Each state is asked to outline the local, regional and statewide initiatives that aim to improve the various aspects of the Care Continuum and the top 3 most effective strategies that can be promoted for wide-scale implementation. This inventory should be completed in time for the first Learning Session, January 22-23, 2014. 7) Join GlassCubes for H4C Participants NQC will set up a GlassCube for the overall H4C Collaborative and a state-specific GlassCube if wanted. Based the agency email addresses submitted by each state, NQC will add these individuals to GlassCubes. Each state is asked to identify an individual to manage the state-specific GlassCube account. 8) Build Excitement and Commitment within your State to Participate in this Initiative It is critical to share information about this collaborative with agencies statewide and answer any questions regarding the H4C in your state. Build excitement and commitment. Time Table of Pre-Work Assignments: Due Date Who Submits Assignment Agencies Join GlassCubes Immediately All Build Excitement and Commitment within your State for H4C Response Team List of Response Team members with defined roles By Friday, Agencies Health IT Assessment Survey Dec 27th Response Team Form State Team Letter of Commitment Response Team Create Story Board In time for Response Team Draft Aim Statement Learning Response Team Submit Inventory of HIV Care Continuum Improvement Strategies Session 1 and Initiatives **All documents should be uploaded to GlassCubes and brought in hardcopy to the first Learning Session.** H4C Pre-Work Manual November 22 nd, 2013 Page 4 of 29

B) CROSS-PART COLLABORATIVE OVERVIEW Welcome to the HIV/AIDS Bureau (HAB) HIV Cross-Part Care Continuum Collaborative, led by the National Quality Center (NQC). This is the seventh in a series of Collaboratives or Demonstration Projects sponsored by the HIV/AIDS Bureau which have included Collaboratives for Part C and D; Part A; Part B; Part B Low Incidence States; AETC; 5-State Cross-Part; and DC Cross-Part. This section provides you with an overview of H4C, a schedule of activities, and a list of pre-work activities and tasks for you to accomplish before the first Learning Session. Overview A Collaborative is a systematic approach to health care quality improvement in which systems, organizations, and providers test and measure innovations, then share their experiences in an effort to accelerate learning and widespread implementation of successful change concepts or ideas. Overall Structure of the Quality Management Cross-Part Collaborative The HIV Cross-Part Care Continuum Collaborative will engage Ryan White Program-funded grantees across all Parts, including grantees from Mississippi, Arkansas, Missouri, Ohio, New Jersey, and Maryland. The purpose is to jointly improve HIV care across constituencies, working together intensely for a period of 18 months, launching in January 2014. During that time, participating states will send leadership representatives to participate in four to five face-to-face Learning Sessions (LS) and maintain continual contact with each other, NQC, and HAB through e-mail, GlassCubes, and conference calls. Collaborative Milestones There are three basic milestones within the Collaborative process: 1) Vanguard meeting and Pre-Work activities; 2) Learning Sessions; and 3) Action Periods. These milestones correspond with the key elements of the Learning Model, adapted from the Institute for Healthcare Improvement s Breakthrough Series. IHI Learning Model (Adapted from the IHI Breakthrough Series) H4C Pre-Work Manual November 22 nd, 2013 Page 5 of 29

Pre-Work The Pre-Work phase includes the period between the September 24, 2013 Vanguard and the 1 st Learning Session being held January 22-23, 2014. During this time, your agency has a few important tasks to accomplish. These tasks are listed and described in detail on page 13 of this Pre-Work Document. Learning Sessions Learning Sessions are the major integrative events of the Collaborative. Response Team members from each participating state will attend four to five interactive face-to-face Learning Sessions, where they will learn methods for testing and implementing changes to improve the quality of care. That representative will then be responsible for disseminating what they ve learned throughout the HIV providers in their states and downstream to provider agency staff. Through plenary sessions, small group discussions, and team meetings attendees have the opportunity to: Learn from expert Faculty and colleagues Network with Faculty members and colleagues Gather new knowledge on the subject matter and process improvement Share experiences and collaborate on improvement plans Problem-solve improvement barriers Action Periods The time between Learning Sessions is called an Action Period. During Action Periods, Grantees and subgrantees participating in the State Teams work within their agency to test and implement improvements. Agencies try out multiple changes and collect data to measure the impact of the changes. Although participants focus on their own agency, they remain in continuous contact with other agencies in their states, their state Response Team, HAB, and NQC. This communication takes the form of conference calls, e-mails, listserv, and GlassCubes posts. In addition, Grantees and sub-grantees share the results of their improvement every other month when they submit performance data to their state Response Team. Participation in Action Period activities is expected to expand beyond those who attend the Learning Sessions and should include all state team members. It is encouraged and expected that other members and support persons in your agency, including leadership, participate in Action Period activities. Schedule The sequence of events following the Vanguard Meeting for the Collaborative is as follows: H4C Pre-Work Manual November 22 nd, 2013 Page 6 of 29

Activities Planning Group formed Monthly Planning Group Calls Development of Concept Paper Selection of Grantees A U G S E P 2013 2014 O N D J F M A M J J C O E A E A P A U U T V C N B R R Y N L A U G S E P O C T N O V D E C Selection of Measures Vanguard Meeting Pre-Work Assignments Initial Monthly Call Learning Sessions Reporting Cycles Monthly Calls Team Leader Calls Coaching Calls H4C Pre-Work Manual November 22 nd, 2013 Page 7 of 29

C) H4C BACKGROUND The National HIV/AIDS Strategy, released in 2010, identified the need for an increase in the number of HIV-infected individuals with undetectable viral loads, and serves as a foundation for the national response to the epidemic and a primary goal for Ryan White HIV/AIDS Program grantees. The first step towards achieving this goal is to establish a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV and to reduce viral load in those communities where HIV incidence is high. 1 Along with the National HIV/AIDS Strategy, the framework set forth in the HIV Care Continuum 2 has also garnered national attention. On July 15, 2013, the U.S. President signed an Executive Order 3 to accelerate improvements in HIV prevention and care in the United States through the application of the HIV Care Continuum. The Executive Order states that data released by the Centers for Disease Control and Prevention show that there are significant gaps along the HIV Care Continuum -- the sequential stages of care from being diagnosed to receiving optimal treatment. This renewed focus on the HIV Care Continuum will enable HIV providers to meet the goals of the 2010 Strategy and move closer to an AIDS-free generation. The national priorities of increasing access to HIV care and viral load suppression will be the focus of the upcoming Collaborative - a peer learning opportunity of regional HIV providers across Ryan White funding streams, whose underlying assumption is that a single grantee or single Ryan White Part funding stream cannot achieve these aims alone. All HIV providers must be engaged together to keep individuals living with HIV involved in ongoing HIV care and to achieve high viral load suppression rates, both of which are necessary to maintain long-term health and reduce the risk of transmission to others. The National Quality Center (NQC) in partnership with HIV/AIDS Bureau (HAB) has the unique capacity to implement a large-scale quality improvement collaborative and to affect measurable improvements in broad geographic regions utilizing the HIV Care Continuum. Based on expert consultation, the HRSA/HAB Engagement in Care Continuum model 4,5 assists service providers and policymakers in designing programs that meet clients variable needs (Figure A). At one end of the Continuum are those who are completely unaware of their HIV status and thus not in care, while at the opposite end of the spectrum are those fully engaged in continuous HIV care. In between are individuals who are engaged in care to various degrees. Figure B demonstrates the link between this Continuum and improved outcomes for people living with HIV, specifically as those outcomes related to viral load suppression and survival. Ideally, HIV-infected individuals should progress from HIV diagnosis to linkage with an HIV 1 The President of the United States and the White House Office of National AIDS Policy, National HIV/AIDS Strategy, (July 2010): p. ix. <http://www.whitehouse.gov/administration/eop/onap/nhas> 2 While the terms HIV Care Continuum and Treatment Cascade are often used interchangeably, the Collaborative will use the term HIV Care Continuum in order to align with the language of the President s Executive Order. 3 <http://www.whitehouse.gov/the-press-office/2013/07/15/executive-order-hiv-care-continuum-initiative> 4 Health Resources and Services Administration, HAB. August 2006. Outreach: Engaging People in HIV Care Summary of a HRSA/HAB 2005 Consultation on Linking PLWH Into Care. 5 Eldred L, Malitz F. Introduction [to the supplemental issue on the HRSA SPNS Outreach Initiative]. AIDS Patient Care STDS 2007; 21(Suppl 1):S1 S2. H4C Pre-Work Manual November 22 nd, 2013 Page 8 of 29

care provider to maintain full engagement in high-quality HIV care with undetectable viral loads. However, the reality is quite different. Figure A: Engagement in Care Continuum Figure B: Linkage to Care and Improving Outcomes With permission from Giordano, et. al. (2005) Current HIV/AIDS Reports. 2: 177-83 In addition, the Centers for Disease Control and Prevention released data demonstrating that of the estimated 1.1 million individuals estimated to be living with HIV in the United States at the end of 2009 (including aware and unaware), 82% were diagnosed, 66% were linked to care, 37% were retained in care, and 25% were virally suppressed. 6 6 Irene Hall and CDC, HIV in the United States: the Stages of Care, Centers for Disease Control and Prevention (July, 2012) <http://www.cdc.gov/nchhstp/newsroom/docs/2012/stages-of-carefactsheet-508.pdf>; this data set will be routinely updated. H4C Pre-Work Manual November 22 nd, 2013 Page 9 of 29

More recently, HRSA/HAB presented data on the Ryan White population. Of the HIV-infected clients who received Ryan White-funded HIV care in 2010 and had relevant data available, 76% were retained in care and 70% were virally suppressed. 7 [Note: the denominator populations for the CDC continuum and the HRSA/HAB continuum are different.] When Ryan White grantees across Parts work in partnership toward common goals, they have the potential to strengthen their individual programs and to accelerate the pace of improvement. By working collectively, grantees increase their potentials to improve the overall quality of HIV care and to meet the needs of clients in their region, leaving a lasting legacy of regional improvements. The ultimate aim of this upcoming Collaborative, sponsored HAB and administered by NQC, is to increase the number of HIV-infected individuals with undetectable viral loads using the HIV Care Continuum as a framework, thus improving the quality of HIV care and related health outcomes. Overview The HAB/NQC HIV Cross-Part Care Continuum Collaborative (H4C) will focus on states that have been identified by HAB with the potential for measurable improvements: AR, IN, MD, MO, MS, NJ, and OH (See Appendix A). Based on 2010 RSR data and input from the HAB Divisions, these states have been shown to likely benefit from a cross-state collaborative effort to improve retention and HIV viral suppression and thus have been asked to participate. H4C will engage grantees from all Ryan White Part funding sources in these six states and will benefit regional teams focusing on viral load suppression while fostering a quality infrastructure built to self-sustain their efforts beyond the formal HAB/NQC sponsorship of the Collaborative. It is the aim of this national quality initiative not only to improve viral load suppression rates but also to potentially impact other components of the Care Continuum. 7 Doshi RK, Matthews T, Isenberg D, et al. Continuum of HIV care among Ryan White HIV/AIDS Program clients, United States, 2010. Paper presented at: 20th Conference on Retroviruses and Opportunistic Infections 2013; Atlanta, GA. H4C Pre-Work Manual November 22 nd, 2013 Page 10 of 29

Aims HAB has sponsored the development of the upcoming HIV Cross-Part Care Continuum Collaborative with the following three aims in mind: Build regional capacity for closing gaps across the HIV Care Continuum to ultimately increase viral load suppression rates for individuals living with HIV Align quality management goals across all Ryan White HIV/AIDS Program Parts to jointly meet legislative quality management mandates Implement joint quality improvement activities to advance the quality of care for people living with HIV within a region and to coordinate HIV services seamlessly across Parts The following outcomes have been established to measure the success of the HIV Cross-Part Care Continuum Collaborative: Suggested Health Outcomes: # (TBD) HIV-infected patients across all H4C states who were not viral load suppressed at the onset of the Collaborative became viral load suppressed during the Collaborative # (TBD) HIV-infected patients across all H4C states who were not in HIV care at the onset of the Collaborative were re-engaged in ongoing HIV care during the Collaborative # (TBD) individuals who were diagnosed with HIV in the last 3 months prior to the Collaborative stayed in ongoing care for the course of the Collaborative The following tables outline the three Collaborative Aims, their specific objectives, benchmarks to evaluate their success and a measurement overview: Aim 1: Build regional capacity for closing gaps across the HIV Care Continuum to ultimately increase viral load suppression rates for individuals living with HIV, as evidenced by: Objectives Benchmarks Measurement Details Regional HIV Care Continuums are routinely available to local HIV providers to identify gaps in HIV care HIV providers routinely measure key HIV metrics and use the findings for prioritizing improvement activities 100% of H4C grantees received a local Care Continuum to inform them about patient retention and viral suppression in their regions 100% of H4C grantees received a training on how to effectively interpret data from the local Care Continuums to improve HIV care 80% (?) of H4C grantees submitted their performance on Collaborative measures after the second reporting cycle and 100% by the close of the collaborative 100% of H4C grantees receive a statewide benchmarking report after each reporting cycle 100% of participating sites have improved their performance scores, comparing the baselines data with subsequent data - bi-monthly report from Response Team- - survey with grantees at the closing of the Collaborative on continuum training - bi-monthly survey with Response Team-NQC - performance data analyses at each learning session and at closing of the Collaborative-NQC H4C Pre-Work Manual November 22 nd, 2013 Page 11 of 29

submissions Aim 2: Align quality management goals across all Ryan White HIV/AIDS Program Parts to jointly meet the legislative quality management mandates, as evidenced by: Objectives Benchmarks Measurement Details Response Teams are actively coordinating and aligning statewide quality management activities HIV providers work together and articulate regional quality improvement strategies HIV providers have the capacity for quality improvement Consumers have the capacity to be meaningfully involved in quality activities 100% of H4C states have in place an active Response Team after the first Learning Session to foster cross-part alignment, partnership and collaboration among regional RW grantees 100% of H4C states report their improvement activities every other month 100% of H4C Response Teams have monthly conference calls with their assigned QI coaches 100% of H4C states maintain a Response Team three months after the official closing of the Collaborative to indicate a sustainable quality improvement infrastructure 100% of all H4C states have a sustainability plan in place prior to the last learning session that describes how the activities will occur in the beyond the formal HAB/NQC Collaborative sponsorship 100% of H4C states have a written statewide quality management plan with the participation and agreement of regional grantees to actively guide and coordinate regional quality management activities 100% of H4C states have established a statewide educational plan to advance quality management competencies of HIV providers and consumers alike # (TBD) HIV providers have increased their quality improvement capacity by successfully attending a QI training session 80% (?) of all training participants rated the quality improvement training as helpful, useful and applicable for their work environments 80% (?) of all training participants have applied the training content in their HIV programs # (TBD) consumers of HIV services have been trained on quality improvement 80% (?) of all consumer training participants rated the quality improvement training as informative and practical 50% (?) of all consumer training participants are involved in some quality improvement - bi-monthly survey with Response Team-NQC - survey with Response Team three months after the Collaborative-NQC - state-specific sustainability plans - bi-monthly survey with Response Team-NQC - training surveys of participants-response Team, NQC - follow-up survey with training participants-nqc - pre/post QI capacity survey with grantees-nqc - training surveys of participants-response Team, NQC - follow-up survey with training participants-nqc H4C Pre-Work Manual November 22 nd, 2013 Page 12 of 29

aspects (i.e., member of a QI team, reviewed performance measurement results) 100% of all H4C states have at least one active consumer representative on their Response Teams Aim 3: Implement joint quality improvement activities to advance the quality of care for people living with HIV within a region and to coordinate HIV services seamlessly across Parts, as evidenced by: Objectives Benchmarks Measurement Details Joint quality improvement projects are conducted to foster active and effective regional collaborations Grantees across each state are better aligning their improvement goals and efforts Methods 100% of H4C states have established a written aim statement for participation in the Collaborative 100% of H4C states have established a QI team to improve viral suppression and retention rates across local grantees 100% of all QI teams report measurable improvements for their projects at the end of the Collaborative 100% of H4C states report an improvement in the collaboration between RW grantees across the state - bi-monthly survey with Response Team-NQC - audience-response surveys at each Learning Session using the NQC Cross-Part Collaboration Assessment Tool-NQC - survey with grantees at the closing of the Collaborative- NQC The HAB/NQC HIV Cross-Part Care Continuum Collaborative (H4C) will engage six regional state teams that are comprised of all Ryan White Program-funded grantees across all Parts and other identified stakeholders (including consumers) in the specified state, representing the diversity of HIV care and service providers. Each of the six states referenced above is invited by HAB to participate in this 12-18 month long activity along with all Ryan White funded grantees and other stakeholders in their states. Each team should aim to include all Ryan White Parts, Medicaid, Epidemiology/Surveillance, existing HIV networks, consumers, and local and regional public health leaders. The Vanguard Meeting with national experts and local HIV providers will be held on September 24, 2013 to facilitate further planning. The Collaborative will kick off in Fall 2013 for 12-18 months, with face-to-face meetings every four-six months and with routine webinars, supplemented by local or regional meetings of each state team. A Collaborative Planning Group will be formed with representatives from HAB, NQC and a core group of national quality improvement coaches who support the assigned state teams. The Group will plan all collaborative activities and will closely scrutinize all Collaborative processes. H4C Pre-Work Manual November 22 nd, 2013 Page 13 of 29

Once the state teams are formed, each team will be asked to complete pre-work tasks including: Proposed membership of Response Team (a cross-functional group of 5-10 local quality leaders representative of Ryan White grantees across the entire state/region and at least one consumer) Baseline statewide viral suppression and retention data with an analysis of data gaps, limitations, strengths, etc. Drafting of an aim statement to articulate state-specific goals and objectives for this Collaborative Submission of an updated participating grantees team list with contact information (agency lead name/phone/email/location/part funding) Compile a list of the quality management data sources used by each grantee (e.g. electronic health record, CAREWare, HIVQual, homegrown database, chart review, etc.) Scheduling of a regional, cross-part Organizational Assessment (OA) for the first meeting to establish baseline A regional Response Team will be formed with grantee representatives to allow for better coordination of statewide quality improvement activities. This Response Team will have team members across all Parts with specified roles and responsibilities (including team leaders, data liaison, capacity builder, communicator, improvement liaison, consumer representative, etc.) and will provide sustainable leadership for their respective regions. Each state team must have a Response Team, and this leadership group will be invited to participate in face-to-face meetings, affording an opportunity for sustainability in improving viral load suppression in ongoing processes and infrastructures. Each Response Team will be supported by an assigned improvement coach. In between face-to-face meeting, Response Team leaders will be invited to join conference calls to discuss their progress in meeting goals and objectives across teams. During the Collaborative, all state teams represented by their Response Teams will take part in face-to-face Learning Sessions every four to six months and maintain continual contact with each other and Planning Group members through conference calls and emails. Over time, a community of learning will develop in which teams will collaborate to share good ideas and best practices, as well as raise issues and lessons learned. Finally, the Collaborative will share its findings and achievements with other states, regions and stakeholders in order to facilitate wide-spread national improvement efforts. The Collaborative will include a regular newsletter that compiles activities across the states enrolled in the Collaborative, and the Response Teams will catalogue changes and improvements within their respective areas. Expectations To ensure immediate initiation and active participation in all Collaborative activities, the following expectations are outlined for participating states in this Collaborative: Establishment of a state-wide Response Team, representative of the various Parts and jurisdictions H4C Pre-Work Manual November 22 nd, 2013 Page 14 of 29

Bi-monthly reporting of identified Collaborative measures, selected from established HAB measures, by all RW grantees in the state Bi-monthly reporting of improvement activities by the Response Team with input/feedback by the assigned improvement coach Development of a statewide HIV Care Continuum and as well as local continuums to maximize the use of these regional data by HIV providers At least one annual state-wide quality improvement training or a series of local quality improvement trainings to build capacity for quality improvement among HIV providers At least one annual quality improvement training for consumers to increase the number of HIV-infected individuals actively participating in quality management committees or quality improvement teams Initiation of a statewide quality improvement project focusing on a key aspect of the Care Continuum: viral load suppression or retention Development of an aim statement at the kick-off of the Collaborative by each state to outline individualized improvement objectives and measurable goals Development of a written, state-wide quality management plan (and related implementation work plan) to describe the QM infrastructure, the involvement of key stakeholders (including RW grantees and consumers), and the role and responsibilities of the Response Team Benefits At the end of this Collaborative, the following benefits will have been achieved: Improved viral suppression and retention rate Concrete understanding of the utility of the HIV Care Continuum for furthering the National HIV/AIDS Strategy Implementation of the July 15 th, 2013 Executive Order by focusing quality efforts on the Care Continuum Ability to produce local HIV Care Continuum data on a regular basis and to share with local/regional HIV providers and constituencies Implementation of system- and grantee-level changes aimed at improving viral load suppression and retention Strengthened regional partnerships across Parts as evidenced by: a sustainable infrastructure for the purpose of collaboration for quality management; region-wide quality management priorities; joint training opportunities; and improved working relationships across Ryan White grantees Routine measurement of key viral suppression and retention performance measures for strategic planning and quality improvement processes; data routinely collected based on standardized data collection methodologies and used for quality improvement At least one formal quality improvement project on viral load suppression or retention, where each grantee will contribute to its success A unified, regional cross-part quality management plan for each Collaborative state supported by a work plan for implementation A Response Team of local quality champions formed in each participating state to guide viral load suppression efforts throughout the Collaborative and beyond H4C Pre-Work Manual November 22 nd, 2013 Page 15 of 29

Increased capacity of HIV providers and selected consumers through participation in state-wide quality improvement training activities and the participation of HIV-infected individuals on quality management committees or quality improvement teams Assumptions The following assumptions will guide the planning and implementation of the Collaborative: Performance measurement throughout the Collaborative will be selected from existing HRSA/HAB and HHS measures; participants will be provided with these measures and their definitions; performance data will be broken down by race/ethnicity, gender, and age. A clone of the online in+care Campaign database or another user-friendly and universally available application will be considered as the Collaborative data collection platform to submit the state-wide performance data every other month Quality improvement updates will be submitted to the assigned improvement coach for feedback and additional input and then will be forwarded to the Collaborative Planning Group to report on data follow-up activities, QI projects, QM infrastructure updates and offers and requests for other teams Measure definitions will be incorporated into grantee data collection tools whenever possible; HAB will work with CAREWare to facilitate reporting performance measures A dedicated website will be available to publicly post information pertinent to the collaborative and to disseminate Collaborative findings and news beyond the members of the Collaborative Virtual bulletin board communities will be established in GlassCubes to facilitate planning and interaction in a confidential, password protected manner Existing HIVQUAL Regional Groups and other teams will be integrated into the Collaborative and/or existing regional groups will be expanded to incorporate all members of Collaborative Face-to-face meetings of the state Response Teams will occur in Washington, D.C. and in other cities within states participating in the Collaborative on an alternating basis; the Response Team will represent the entire continuum of Ryan White grantees at these meetings NQC and HAB will expect Collaborative participants to meet within their regions in between NQC-scheduled face-to-face Learning Sessions NQC and HAB will expect Response Team leaders to join monthly leader calls to share their progress across teams between face-to-face learning sessions List of Activities Vanguard Meeting: A meeting will be held before the selection of the Collaborative participants with key stakeholders including representatives from HAB, NQC, and other stakeholders with relevant experience to assess the needs and priorities and to finalize the technical assistance strategies for this Collaborative. Learning Sessions: Participating response teams will meet together with the faculty every four to six months during the Collaborative to learn from each other, to share experiences, to receive coaching from assigned improvement coaches and to develop new H4C Pre-Work Manual November 22 nd, 2013 Page 16 of 29

plans for action and tests for change. The final meeting will transition this Collaborative to community leadership and will take stock of progress made, lessons learned and best practices revealed during the HAB/NQC management phase to share with other grantees. Planning Group: Each participating regional team will have an NQC quality improvement coach available to help coordinate the Collaborative efforts. The Planning Group will include NQC staff and HAB staff, including branch chiefs and project officers. Webinars: Routine webinars will be held between learning sessions on needed topics that arise from the group and will include content experts when appropriate. These calls will also allow the faculty to communicate with the teams, ensure progression and discuss any issues that may arise. Regional QI Trainings: As needed, NQC will visit Collaborative regional teams and train participants on pertinent quality management and quality improvement issues. Each team will be visited by faculty trainers once. Reporting: Participating teams will be responsible for tracking and reporting data bimonthly on a uniform set of outcome and process measures in addition to the individual measures that each grantee wishes to track. A standard reporting template, provided by NQC, will include performance data, data follow-up activities, QI projects, quality management infrastructure updates and offers and requests for other teams. The Planning Group will meet jointly to review all reports submitted and will send teams individual feedback and aggregate findings each reporting period. GlassCubes: NQC will launch a password-protected online forum (called GlassCubes) for registered users of the Collaborative to share quality improvement resources, post project-specific messages, and maintain a library of documents relevant to the Collaborative. Each regional team will have the opportunity to manage their own GlassCubes space and post documents relevant to the work being done in their specific area. Final Report and Documentation: NQC will summarize progress and best practices from this Collaborative, and a final report will be developed. H4C Pre-Work Manual November 22 nd, 2013 Page 17 of 29

This section includes the following items: 1. Establishing an Aim Statement 2. Model for Improvement 3. Team Dynamics 4. Getting the Most from Your Team 5. Organizing the Team 6. Team Documentation 1) Establishing an Aim Statement D) RESOURCE SECTION Every state participating in the Collaborative will write an Aim Statement in preparation for the first Learning Session held on January 22-23, 2014. An Aim is an explicit statement summarizing what your state plans to achieve during the Collaborative with regard to improving state performance on the HIV Care Continuum. It should be time-specific and measurable. The Aim should be also unachievable in the current system of care. In addition, it should emphasize that system redesign will be taking place. Specifically, the Aim Statement should take a narrative tone that focuses on the purpose of your state s involvement in the Collaborative. Each state should have 2-4 specific goals toward the Aim your state wants to concretely accomplish in the next 18 months based on the participation in this Collaborative. These should be stretch goals that would be otherwise unachievable and that will push you and your state to get the most out of the Collaborative. The Aim should be as concise as possible. H4C Example Aims Statements [State Team] will improve its HIV Care Continuum to provide improved care for our patients living with HIV. We will focus initially on ART adherence in an effort to ultimately improve viral load suppression within our community from currently 65% to 75% by May 2014. This will be evidenced by: - At least 90% of eligible patients with an active ART prescription - Follow up with 100% of patients who have not filled prescriptions - At least 80% of patients provided with consistent messaging on the importance of ART adherence - At least 90% of opioid-dependent patients receiving methadone maintenance treatment receive DAART simultaneously - 90% of providers are trained on the latest ART guidelines [State Team] will improve its HIV Care Continuum to provide improved care for our patients living with HIV. We will focus initially on improving viral load suppression within our patient population. This will be evidenced by: - At least 80% of patients viral load suppressed by Jan 2014 from baseline 72% in Dec 2012 - At least 80% of patients provided with consistent messaging on the importance and benefits of viral load suppression - At least 70% of patients who are ART adherent but remain not viral load suppressed are genotype or phenotype tested for drug resistance - 90% of patients have a viral load test at every 6 months [State Team] will improve its HIV Care Continuum to provide improved care for our patients living with HIV. We will focus initially on short term retention in care resulting in a viral load suppression rate of 85% by June 2014. This will be evidenced by: H4C Pre-Work Manual November 22 nd, 2013 Page 18 of 29

- Follow up with 100% of patients who missed a medical appointments in the last 30 days via phone - Reschedule medical appointments with at least 80% of patients who missed their medical appointments - At least 80% of patients provided with consistent messaging on the importance of retention in care - 90% of patients with upcoming appointments provided with 2 forms of reminders: by mail and by phone [State Team] will improve its HIV Care Continuum to provide improved care for our patients living with HIV. We will focus initially on long term retention resulting in a viral load suppression rate of 85% by June 2014. This will be evidenced by: - Follow up with 100% of patients who have not had a medical appointment in the past 6 months via phone - Schedule medical appointments with at least 60% of patients without an appointment in the past 6 months who are out of care - At least 50% of patients who are out of care are discussed in case management rounds to strategize outreach efforts - 90% of patients asked to update their contact information on each medical visit 2) The Model for Improvement In addition to the Breakthrough Series Model, the Collaborative uses an improvement model developed by the Associates in Process Improvement that has been tested and used in many Collaboratives. When used to test either confirmed or proposed best ideas for change, the improvement model provides a process to improve the quality of care at an accelerated pace. The Improvement Model is based on three fundamental questions: 1. What are we trying to accomplish? The first question is meant to establish an Aim for improvement that focuses group effort. Using data and what patients and other customers, such as payers, believe are important helps define an Aim. Aims should be as concise as possible sometimes it takes a few trials of testing an Aim before it becomes truly focused. 2. How will we know that a change is an improvement? Measures and definitions are necessary to answer this question. Data is needed to assess and understand the impact of changes designed to meet an Aim. When shared Aims and data are used, learning is further enhanced because it can be shared with other organizations in the Collaborative. In this way, superior performance and best practices are more quickly identified and disseminated through benchmarking. 3. What changes can we make that will result in an improvement? Testing and Learning: The PDSA Cycle is a trial-and-learning (learn by test) method to discover what is an effective and efficient way to change a process. The study part of the Cycle may require some clarification; after all, we are used to planning, doing and acting. The emphasis on study is the key to learning and establishes knowledge. It compels the agency to learn from the data collected, its effects on other parts of the system and on patients and staff, and under different conditions, such as different services or sites. Most importantly, the study phase is an ideal time to generate new ideas and approaches to positive change. In addition, the PDSA Cycles are short and quick. H4C Pre-Work Manual November 22 nd, 2013 Page 19 of 29

3) Team Dynamics All teams, as part of their development, go through different stages as they develop into a high performing team. It is helpful to recognize these stages and not let them detract from the Collaborative work. These descriptions and recommendations are useful both for the Response Team and participating agencies. (Source: The One-Minute Manager Builds High Performance Teams) Teams are not static Teams can get stuck Teams can regress Teams can skip stages Large teams means more complex relationships and communications and more subgroups Team members must move from individual rewards/behavior to team behavior/rewards Stage 1: Orientation Eager with high expectations Anxiety about fit and expectations Testing situation and central figures Assessing authority and hierarchy Needing to find a place and establish oneself Stage 2: Dissatisfaction Discrepancy between hopes and reality Dissatisfied with dependency on authority Angry about goals, tasks and action plans Feeling incompetent and confused Negative towards leaders and teams Competing for power and/or attention Experiencing dependence/counter-dependence Stage 3: Resolution Decreasing dissatisfaction Resolving discrepancies between expectations and reality Resolving animosities and polarities Developing harmony, trust, support, and respect Developing self-esteem and confidence Being more open and giving more feedback H4C Pre-Work Manual November 22 nd, 2013 Page 20 of 29

Sharing responsibility and control Using team language Stage 4: Production Excited about participation Working collaboratively and inter-dependently Feeling team strength Showing high confidence in accomplishing tasks Sharing leadership Feeling positive about task successes Performing at high levels 4) Getting the Most from Your Team Strategic planning: Establish and communicate purpose, conduct planning for improvement and integrate it into the business plan. Develop a cooperative, connected network: View your agency as a system. Build capacity for improvement: Design and manage a system for gathering information for improvement and sustaining changes. Develop Executive sponsorship: Charter and coach individual during team improvement activities. Utilize Technical support: Advice from the experts outside the team. Use Knowledge management: Developing a system to synthesize, integrate and spread knowledge so everyone is on the same page. Strategic Planning Change requires direction. Leaders are responsible for helping to align the work of the team with the key strategies of the Collaborative and agency. If the work of the team is not linked to the overall strategy, then the work becomes simply a time limited project. Constancy of purpose requires that every individual understands the purpose of the work and how their role helps accomplish that purpose. Knowing and communicating the purpose provides the team with constancy of purpose. Linking the work of the team to the strategic vision will help maintain a long-term focus on improving clinical and administrative quality. Leadership can support constancy of purpose by doing the following: Communicating the purpose (mission or vision statement) and how the team s work helps accomplish the purpose. Incorporating improvement activities into the strategic plan and business plan; plan for improvement. Using the mission or vision statement to provide a broad Aim for every improvement effort, so as the team develops their Aim Statement there should be something in the vision or mission statement that it is connected to. Allocating resources for the team to accomplish the improvements, such as time to meet on a regular basis, a computer with internet access, equipment, or technical assistance from others. Balancing short-term needs with long-term improvements, the business plan must include improvement work or the work will never get done. Providing opportunities for everyone to become involved with the improvement. As the team tests and redefines the system of care, get everyone involved in the spread of improvement. If the improvement work of the team is not related to the vision, strategic plan, business plan, or performance improvement plan, it cannot be sustained. H4C Pre-Work Manual November 22 nd, 2013 Page 21 of 29

Cooperative, Connected Network Whatever it is called in your agency QA, QI, CQI, PI, TQM improvement efforts must be continuous, coordinated and focused on the organization s purpose. The work of the team will be to raise important issues and to develop and implement changes related to these issues. In order for lasting change to occur the Cross-Part QM Program must view itself as a system and operate as a system. This requires relating all of the components of the Cross-Part Program back to the common purpose and how the team relates to that purpose. Changes in one area may have impact on another. As the team tests the changes they will need cooperation and objective feedback from individuals in these other parts of the system. The team will have a set of measures that will provide indicators of present performance and predictors of how the system will perform in the future. These measures, as well as tests around the core areas for improvement, are documented in the routine report. Integrating the report into the agency and Collaborative wide quality management infrastructures provides the opportunity for everyone to understand the team s work and provide assistance as needed. This also increases the view that improvement is everyone s responsibility not just the team s responsibility. The leader role is to make this happen. Building Capacity for Improvement Occasionally improvement occurs and nobody knows why; then it disappears and nobody knows why. Sustained improvement is accomplished by premeditated planning and testing and by deliberate action to integrate the change into the system. An improvement team may find all the needed improvements, but if the changes are not integrated into the system they won t produce long-term results. The investment of resources to the team demands that the results are sustainable and duplicable. In other words, the skills and models they will learn are applicable to many improvement efforts and need to be incorporated into the performance improvement plan. Everyone must know how to use these skills. Actions the leader can take to build capacity for improvement: Publicize the work of the team: There are many ways to accomplish this: You may post your storyboard in an area trafficked by staff or post a monthly update openly in a prominent place. Involve and train other staff: The Response Team and agency representatives have a responsibility to train others in the Collaborative and in their agencies in the skills and tools of the Collaborative. Support the team: If the senior leader clearly acknowledges the importance of the work of the team, it becomes an organizational priority. Integrate the models into the performance improvement plan: The models must become a way of organizational improvement life. If it is to be sustained, collaborative work cannot be a stand alone. Plan for how you intend to spread the work of your team. Knowledge Management Improvement efforts provide a wealth of knowledge in lessons learned, failed tests, and successful tests. Testing on a small scale creates a low risk environment for learning. This knowledge will be shared in routine reports. Important processes to be developed as part of knowledge management: Publicize the team s work for all staff: Either a monthly update, data graphs, or a storyboard to show the progress over time. Develop a Collaborative Notebook that includes the reports, tests, and work plans of the team: This historical data will be invaluable to the current team and future teams as well as a means of presenting the improvement work to external reviewers. Create a process for training other staff in preparation for new teams. Integrate the models as part of new staff/provider orientation. As improvements are made, make sure the old way of doing things is not an alternative. H4C Pre-Work Manual November 22 nd, 2013 Page 22 of 29

5) Organizing the Team For the first team meeting establish the Ground Rules. Ground rules are the rules a team makes to govern themselves and their behavior as team members. THIS IS AN IMPORTANT STEP DON T SKIP IT! Basic Ground Rules to Be Addressed: Attendance: A high priority is set on attendance. Discuss what legitimate reasons for missing a meeting are and establish a procedure for informing the Secretary/Recorder of the member s absence. Promptness: Meetings start and end on time. Everyone is on time for meeting. Meeting time and place: Specify a regular meeting time and place, and establish a procedure for notifying members of the meetings. Participation: Every team member s contributions are important. Establish the importance of speaking freely and listening attentively. Basic conversational courtesies: Listen attentively and respectfully to others. Don t interrupt one conversation at a time. The Communicator and Team Leader hold the right to halt members who do not adhere to the rules. Assignments: Since much of the team s work is done between meetings, members must be accountable for completing their assignments on time and reporting back to the team. Rotation of chores: Determine a rotation of routine housekeeping chores for all team members, so no one feels overwhelmed or stuck. Agendas, minutes, & records: Although the Secretary/Recorder is ultimately responsible for these activities, others may be assigned the tasks. Decide how these will be handled in your team. Other ground rules: Add any others that the team may feel are appropriate. Note: Team members who show a pattern of breaking the rules of the group may need to be replaced. The intensity, amount of work, and timeframe of the Collaborative require ALL members to carry their weight AND be committed to the work of the team. Set the Meeting Schedule: To accomplish the work of the Collaborative, the team will need a time and place (virtually or in-person) set aside to meet on a regularly scheduled basis. It is vital that a regular meeting schedule be developed. Haphazard meeting times or hallway meetings will not produce an effective team. Initially, the team will need to meet more frequently, but as the work progresses the meetings will be less frequent. General Meeting Rules: Consider these as you set your ground rules: (Largely the Communicator s role) Use and stick to agendas. Start and end on time. Take minutes. Draft next agenda at the end of meeting. Evaluate the meeting, and obtain feedback at the meeting. Were objectives met? Did the meeting move you closer to your Aims? Did you plan or study a test cycle? Effective Discussion Skills for Team Members: Ask for clarification: Keep it simple and clear. Act as gatekeepers: No one dominates the discussion. Expect equal participation among members. Listen: Actively explore other s ideas rather than debating or defending each idea. Summarize: Compile what has been said, and restate it to the group with a question to check for agreement. H4C Pre-Work Manual November 22 nd, 2013 Page 23 of 29

Contain digression: Disallow over long examples or irrelevant discussions. Manage time: Stay on time with the agenda, if items go over recognize that others will be cut short. End the discussion: Learn to tell when nothing further can be gained from a discussion and how to end it. Test for consensus: State decisions made, and check that the team agrees. Constantly evaluate the meeting process: Ask yourselves: Are we getting what we want from the discussion? If not, what can we do differently in the remaining time? Are we on track? Are we being effective? 6) Team Documentation Documentation of the team s work is an important part of the Collaborative process. The team needs the documentation to track their progress and what has been tested. Many teams have successfully used this documentation as part of their accreditation process. Anticipated documentation includes: 1. Team Meeting Agendas 2. Minutes for Team Meetings 3. Project Notebook 4. PDSA Worksheets 1) Team Meeting Agendas: The purpose of the agenda is to structure the meeting, provide a timeline for the meeting, and document topics of discussion. Agenda Example Collaborative Name Date of Meeting: Time of Meeting: Conference Call: Location of Call In Number Expected Attendees: Communicator: ----- Agenda Topics ----- I. Roll Call Cindy (person responsible) 5 min II. Introductions ALL 5 min III. Overview of Project Roberto 10 min IV. Team Development Raysheema 10 min V. Project Notebook Keiko 5 min VI. Q&A ALL 15 min VII. Adjourn H4C Pre-Work Manual November 22 nd, 2013 Page 24 of 29

2) Minutes for Team Meetings: The purpose of taking minutes is to document the discussions, actions, findings, and decisions of the team, as well as future actions required. The notes also provide historical information for future teams looking at a similar process. The best format is one that allows for documentation of: Topic discussed Discussion Conclusions/findings Actions required Responsible person Date expected for completion of actions Minutes Example PARTICIPANTS Minutes taken by: (Team member name) X X Team member name Team member name Team member name Team member name Team member name Team member name Team member name Team member name Team member name AGENDA ITEM DISCUSSION DECISION/ACTION 1. Agenda Item Any key items of discussion or how something is to be done 2. Agenda Item 3. Agenda Item 4. Agenda Item 5. Agenda Item 6. Next Meeting/Call What is to be done By whom Date expected to be done 3) Project Notebook This is not a requirement of the Collaborative, merely a suggestion. Set up a notebook with these tabs: 1. Project Aim: List all Aims for the Collaborative, including the overall objective and concrete measurable goals. 2. Team Meetings: Agenda for each meeting concurrently dated and signed minutes for each meeting. 3. Data Collection & Analysis: File a copy of your reports behind this tab. Include narrative, registry summary reports, and graphs. 4. Project Plans and Action Plans: For each Action Period you will be expected to develop plans for that Action Period and will revise it over the course of the Action Period. File these here. H4C Pre-Work Manual November 22 nd, 2013 Page 25 of 29

E) GLOSSARY OF IMPROVEMENT TERMS AND CONCEPTS Action Period The period of time between Learning Sessions when the agencies work on improvement in their organizations. They are supported by the Collaborative Faculty, the Response Team, and participating agencies via a variety of resources such as listservs, online quality improvement training programs, conference calls, etc. Agency Representatives Representatives from across the participating grantees and subrecipients of the D.C. EMA who drive and participate in the improvement process in their agencies: attending Learning Sessions, meeting regularly, disseminating information, and spearheading QI activities in their agencies. Aim or Aim Statement A written, measurable, and time sensitive statement of the accomplishments a team expects to make from its improvement efforts. The Aim Statement contains a general description of the work, the system of focus, and numerical goals. Annotated Run Chart A line chart showing results of improvement efforts plotted over time. The changes made are also noted on the line chart at the time they occur. This allows the viewer to connect changes made with specific results. Champion An individual or individuals in the agency who believes strongly in quality improvement and is willing to work with others to test, implement, and spread changes. This champion should have a good working relationship with colleagues and with the day-to-day leader(s) and be interested in driving change in the system. Change Concept A general idea for changing a process, usually developed by an expert panel based on literature and practical application of evidence. Change concepts are usually at a high level of abstraction, but evoke multiple specific ideas for how to change processes. Simplify, reduce handoffs, consider all parties as part of the same system, are all examples of change concepts. Change Idea An actionable, specific idea for changing a process. Change ideas can be tested to determine whether they result in improvements in the local environment. An example of a change idea is: Simplify process for data entry by having front desk staff enter visit information daily from a duplicate copy while the original is filed in the chart. Change Package A collection of change concepts and key changes. Collaborative A systematic approach to health care quality improvement in which organizations and providers test and measure practice innovations, then share their experiences in an effort to accelerate learning and widespread implementation of best practices. Everyone teaches, everyone learns. Collaborative Faculty The group of experts on the topic who develop the Collaborative and teach and coach participating teams. Cycle See PDSA Cycle. H4C Pre-Work Manual November 22 nd, 2013 Page 26 of 29

Data Collection Plan A specific description of the data to be collected, the interval of data collection, and the agencies from which the data will be collected. The plan is included in all routine reports. Implementation Taking a change and making it a permanent part of the system. A change may be tested first and then implemented throughout the organization. IS Refers to the information system of an organization or system, usually the computerized information system. Listserv A communication system that allows teams to stay connected with the Faculty and each other during the Action Periods. Sharing information, getting questions answered, and solving problems are all part of e- mail list activity. Measure A focused, reportable unit that will help a team monitor its progress toward achieving its Aim. The Collaborative will have a list of required key measures, as well as a list of additional key measures. Model for Improvement An approach to process improvement, developed by Associates in Process Improvement, which helps teams accelerate the pace of change. The Model includes use of rapid-cycle improvement, successive cycles of planning, doing, studying, and acting (PDSA Cycles). PDSA Cycle Another name for a cycle (structured trial) of a change, which includes four phases: Plan, Do, Study, and Act. The PDSA Cycle will naturally lead to the plan component of a subsequent cycle. Pre-Work Activities to be conducted before the first Learning Session to prepare for work in the Collaborative. Report The standard reporting format for routine reporting progress during the Collaborative. This concise summary report includes an Aim Statement, measures and data, a listing of the changes made, and its results. A reporting template will be provided for this Collaborative. Response Team Those individuals who participant in all calls and Learning Sessions, direct and assist the agency representatives and are accountable for the work of the Collaborative. Run Chart See annotated run chart. Spread The intentional and methodical expansion of the number and type of people, units, or organizations using the improvements. The theory and application comes from the literature on the concept of Diffusion of Innovation. H4C Pre-Work Manual November 22 nd, 2013 Page 27 of 29

Storyboard Displays information about a team and its progress and that is displayed at Learning Sessions to help create an environment conducive to sharing and learning from the experiences of others. Test A small-scale trial of a new approach or a new process. A test is designed to learn if the change results in improvement and to fine-tune the change to fit the organization and patients. Tests are carried out using one or more PDSA Cycles. H4C Pre-Work Manual November 22 nd, 2013 Page 28 of 29

F) FACULTY AND COACH CONTACT INFORMATION Role Name Phone Email NQC Faculty Clinical Direction Dr. Bruce Agins bda01@health.state.ny.us NQC Faculty Program Direction NQC Faculty Program Management NQC Faculty Lead State Coach NQC Faculty Consumer Lead NQC Faculty Consumer Coach NQC Faculty Program Assistance Clemens Steinbock 212-417-4730 Clemens@NationalQualityCenter.org Michael Hager 212-417-4730 Michael@NationalQualityCenter.org Lori DeLorenzo loridelorenzo@comcast.net Daniel Tietz 517-473-7542 det01@health.state.ny.us Adam Thompson 864-354-8468 adamtthompson@gmail.com Hazel Lever 212-417-4730 Hazel@NationalQualityCenter.org HAB Faculty Marlene Matosky mmatosky@hrsa.gov Coach AR Sherry Martin 713-668-9067 sherry@martinconsultants.net Coach MD, OH Hollie Malamud-Price 248-515-4165 holliehivqual@gmail.com Coach MO BJ Boshard boshardb@health.missouri.edu Coach MS Nanette Brey-Magnani 508-735-0290 breymagnan@aol.com Coach NJ Dan Sendzik dps10254@aol.com H4C Pre-Work Manual November 22 nd, 2013 Page 29 of 29