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What are the key HRSA QI Initiatives?

Clinical Quality Performance Measures        

HRSA is implementing a set of 12 performance measures known as the Clinical Quality Core Measure Set.  This new initiative aligns clinical performance measures across HRSA’s clinical service delivery programs and with national quality measures endorsed by many national quality improvement organizations. The Core Clinical Measures Set was approved by HRSA in December of 2006 and is currently available for use by HRSA programs. Four of the measures have already been incorporated into grant guidelines, including those for Health Information Systems Grants, Rural Quality Improvement Grants, and the Consolidated Community Health Centers program UDS reporting tool.  HRSA plans to report performance data from the Consolidated Community Health Centers in January of 2010.  

The Core Measures address priority health conditions of HRSA safety net populations and were selected based on their relevance to HRSA programs.  They include screening for colon, breast and cervical cancer.  These cancers disproportionately affect HRSA populations and early detection and care can significantly decrease mortality and improve 5-year survival.

Prenatal care is also represented with core measures for first trimester care access and prenatal HIV screening.  Chronic disease management for diabetes and hypertension are core measures as well.  Immunizations across the life cycle and for special populations are also included.  These consist of childhood immunizations, adult influenza immunizations, older adult influenza immunizations, older adult pneumococcal immunizations and hepatitis B vaccine for HIV positive patients.

HRSA plans on expanding the Core Measure Set to include areas of mental health, oral health, asthma, obesity, and smoking.  Quality measures for patient safety, patient satisfaction, and health literacy/communication are also being considered.

Related Resource:

Core Clinical Measures – Health Resources and Services Administration                                

Health Disparities Collaborative (HDC)

This is a national effort to eliminate disparities and improve the care provided by HRSA-supported health care providers, such as health centers, and their partners. It includes clinical, financial and operational quality improvement. The HDC strives to translate and disseminate new evidence-based knowledge that will contribute to the transformation of health center care delivery across the nation and to the improvement of systems at individual health centers.  It is a collaborative approach that health centers around the Nation can participate in to gain information and resources enabling them to improve their quality of care.    

Areas of focus included in the HDC include diabetes, cardiovascular disease, asthma, cancer screening and planned care, management and treatment of depression, oral health and prevention, among others.

Related Resource:

Healthcare Communities – The HRSA Health Disparities Collaborative resulted in the development of this knowledge management system that providers can access for resources related to QI.

Patient Safety and Clinical Pharmacy Services Collaborative (PSPC)

The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) is a national effort to improve care delivered by HRSA grantees and other health care providers serving patients with multiple complex conditions by replicating leading practices in patient safety and clinical pharmacy services.  It is a collaboration among over 100 teams of HRSA-funded providers and their community-based, safety net partners who serve large numbers of patients with multiple chronic conditions such as diabetes, obesity, and hypertension.  It uses methods adopted from the Institute for Healthcare Improvement (IHI) to spread evidence-based practices to providers.

The PSPC utilizes learning sessions to provide education from experts in the field.  Action Periods, which take place between each learning session, are used to test, refine, adapt and implement changes. Improvements on a number of measures, including coordination among providers, adverse drug events and clinical pharmacy services, are tracked monthly.

Related Resource:

PSPC Overview – Health Resources and Services Administration

HIV/AIDS Program Quality of Care

Although HIV-related morbidity and mortality has dropped dramatically due to advances in HIV/AIDS treatment, reductions are uneven across HIV-infected populations due to unequal access to care and quality of services provided. HRSA has a number of programs under its HIV/AIDS Bureau (HAB) which focus on the service delivery system at various levels and are designed to help grantees implement quality management programs that target clinical, administrative, and supportive services. HAB has created performance measures to help grantees to meet their HIV quality improvement goals.  While grantees are not required to submit data on their improvement on performance measures, they are strongly encouraged to track them. The performance measures consist of three groups:

• Group 1 measures provide an excellent start and can serve as a foundation on which to build, especially if a clinical program has no performance measures.
• Group 2 measures are important measures for a robust clinical management program and should be seriously considered.
• Group 3 measures represent areas of care that are considered "best practice," but may lack written clinical guidelines or rely on data that are difficult to collect.

In addition to the HAB Performance Measures, HRSA also sponsors the HIVQUAL Continuous Quality Program. The aim of this program is to build capacity and capability among Ryan White HIV/AIDS Program grantees to sustain quality improvement. Participation is encouraged, although it is not required.

Participants in HIVQUAL are coached to develop specific skills in measurement, sampling, identifying opportunities for improvement and conducting projects to improve performance. Once these skills are learned, they can be applied to measure other indicators and to other programs in the organization.  There are a number of HIVQUAL indicators, including clinical visits, HIV specialist care, adherence assessment, STP management, dental care, tobacco use screening, mental health screening and prevention education.

Related Resources:

HIVQUAL Continuous Quality Program – Health Resources and Services Administration
HAB HIV Performance Measures – Health Resources and Services Administration

Maternal and Child Health Bureau Collaborative (MCHB Collaborative)

The Maternal and Child Health Bureau (MCHB) is one of the largest Federal block grant programs. It leads the nation in ensuring the health of all mothers, infants, children, adolescents, and children with special health care needs (CSHCN).   The block grant consists of a number of programs including,  the Women and Infants Objective, Child Health and Safety Objective, Oral Health Objective, Children with Special Health Care Needs Objective, Adolescents Objective,  and the Genetics Objective.

Related Resource:

Maternal Child Health Programs – Health Resources and Services Administration