WHAT IS AN OBJECTIVE REVIEW?• An objective review “Is a process that involves the thorough and consistent examination of applications based on

an unbiased evaluation of scientific or technical merits or other relevant aspects of the review”.

• Reviewers do not make assumptions or judgements during a review• Germane Solutions reviewers are consistent with all External Review Organization Processes

THINGS TO KNOW…..• Reviewers will not ‘dig’ for information, rather it should be very evident where items are

throughout a client file system

• IF YOUR CHARTS LOOK LIKE THIS, THEN YOUR OUTCOMES WILL LOOK LIKE THIS & THE EXIT WILL FEEL LIKE

STANDARDS & MONITORING

• Standards tell you what is being measured

• The Standards incorporate all Federal requirements and DSHS policies

• IF ONE COMPONENT IS MISSING WHEN MONITORING, THE INDICATOR IS NOT MET

This Photo by Unknown Author is licensed under CC BY

This Photo by Unknown Author is licensed under CC BY-NC-SA

SERVICE STANDARDS

• https://www.dshs.texas.gov/hivstd/taxonomy/#section6

MONITORING TOOLS

• https://www.dshs.texas.gov/hivstd/taxonomy/#section6

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Maintain files of eligibility and clinical policies

Maintain file of materials documenting Consumer Advisory Board (CAB) membership and meetings, including minutes

Regularly implement client satisfaction survey tool, focus groups, and/or public meetings, with analysis and use of results documented

PROGRAM SITE: REVIEW DATE:REVIEWER(S):

Maintain visible suggestion box or other client input mechanism

Have billing, collection, co-pay, and sliding fee policies that do not act as a barrier to providing services regardless of the client’s ability to pay

Maintain file of individuals refused services with reasons for refusal specified; include in file any complaints from clients, with documentation of compliant review and decision reached

Universal and Statewide Programmatic StandardsSECTION 1: UNIVERSAL STANDARDS

ACCESS TO CARE

Maintain file of individuals refused services

HRSA/DSHS STANDARD: Structured and ongoing efforts to obtain input from clients in the design and delivery of services

HRSA/DSHS STANDARD: Provision of services regardless of an individual’s ability to pay for the service

HRSA/DSHS STANDARD: Provision of services regardless of the current or past health condition of the individual to be served

WHY DO WE MONITOR?• Monitoring is a program requirement for all Ryan White federal funded programs

• Germane Solutions conducts the quality assurance monitoring for DSHS HIV Care Services Group to determine provider compliance with the Standards

• Providers are then able to determine quality improvement processes that will enhance their compliance with the Standards that ultimately will improvement the client system of care

TIPS TO PREPARE• HAVE ALL ITEMS AVAILABLE AND READY FOR THE REVIEW TEAM BEFORE THE SITE VISIT

• LOOK AT THE DSHS MONITORING TOOLS ALONGSIDE THE RESPECTIVE DSHS SERVICE STANDARD TO UNDERSTAND NUMERATORS/DENOMINATORS THAT DETERMINE THE OUTCOME FOR THE INDICATORS LISTED IN “PERFORMANCE MEASURES”

• BREATHE…..MONITORING IS A PROCESS TO HELP WITH IMPROVEMENT INITIATIVES

CORRECTIVE ACTION PLANS (CAPS)

QUALITY IMPROVEMENT PROCESS• HRSA defines Quality Improvement (QI): “QI consists of systematic and continuous

actions that lead to measurable improvement in health care services and the health status of targeted patient groups”.

• DSHS uses the Plan-Do-Study-Act (PDSA) method for improvement processes. The PDSA cycle is a scientific method used for action-oriented learning and aids organizations to determine whether a change will have the desired outcome or if the change should be reconstructed.

QUALITY IMPROVEMENT PROCESS• SUCCESSFUL PDSAS ARE REVIEWED ON A MONTHLY BASIS WITH AGGREGATED OUTCOMES MEASURED IN

THE FIRST QUARTER TO DETERMINE EFFICACY OF THE ACTION/CHANGE DESIRED SOURCE: HTTPS://WWW.HRSA.GOV/QUALITY/TOOLBOX/METHODOLOGY/QUALITYIMPROVEMENT/INDEX.HTML.

CAPS

PLAN-DO-STUDY-ACT (PDSA)• There are two parts to the Model for Improvement:

• Part 1 guides the improvement work by asking:• What are we trying to accomplish?• How will we know that a change is an improvement?• What changes can we make that will result in improvement?

• Part 2 incorporates the PDSA cycle that tests and implements a change in real-work settings.• One of the most common tools used for improvement is the PDSA cycle (a.k.a. the

Deming or Shewhart Cycle).

PDSA• The PDSA Cycle is best described in stages:

• The PLAN Stage: designed to help the provider determine the who, what, when, and how components of the quality initiative.

• The DO Stage: the testing phase of the cycle wherein the provider determines action steps to implement that are specific to the processes and/or procedures that the team believes will improve outcomes.

• The STUDY Stage: the analysis phase that occurs during the process, where providers will collect/monitor the steps implemented in the DO stage.

• The ACT Stage: the answers from the STUDY stage define if the ACT should be to continue the steps in the DO stage as improvement has occurred or refine the DO stage and STUDYthe new action steps.

PDSA• Additional best practices for developing and implementing successful PDSAs:

1. Work with a team of staff to develop action steps that are realistic.2. The Institute for Healthcare Improvement recommends a simple sampling process that

provides quick data collection to determine effectiveness of the PDSA steps implemented. This is known as Block Sampling.

3. Best practice block sampling uses 10 or more charts per month to review for effectiveness of change implemented. Randomly select 10 client/patient charts from the month completed to review documentation and measure effectiveness of change.

PDSA WORKSHEET