CQII Quality Award Program

logoSince 2007, CQII has recognized organizations and individuals who have made exemplary progress in improving their Ryan White-funded services. The aim of our Quality of Care Award  Program is to celebrate the success of Ryan White HIV/AIDS Program recipients and subrecipients nationally, increase the visibility of quality champions, and provide real world examples that other programs might find useful. Award categories include:

  • Measurable Improvements in HIV Care
  • Leadership in Quality
  • Consumer Involvement in Quality Improvement

We congratulate the 2021 CQII Quality Award Winners:

Measurable Improvements in HIV Care

Southeast Mississippi Rural Health Initiative, Inc. (SeMRHI), Hattiesburg, Mississippi

We congratulate Southeast Mississippi Rural Health Initiative, Inc. (SeMRHI) for their outstanding work around improving their viral suppression rates. We are honored to present them with CQII’s 2021 Award for Measurable Improvements in HIV Care to Mitigate HIV Disparities.

SeMHRI is a network of federally qualified health centers (FQHCs), which provides integrated primary, HIV, and behavioral health care services for people with HIV in southern Mississippi. With 5 school-based health centers, they provide HIV education, prevention, and testing for youth. “What I’m most proud of are the patients,” said Tonya Green, the Director of Social Services and Ryan White Program Coordinator at SeMRHI’s Hattiesburg Family Health Center. “I’m really proud of their willingness to get into care and being proactive in their health care despite all of the stigma. We could not do what we do without these young patients being engaged, open minded, and trustworthy of us in this journey they’re going through.”

SeMRHI participated in CQII’s past two collaboratives (end+disparities Collaborative and create+equity Collaborative) and used data-driven quality improvement techniques to identify youth who are not virally suppressed or have missed appointments. Medical case managers used a patient checklist to identify and address barriers to antiretroviral therapy (ART) and medical care adherence. ‘Health literacy illustration’ tools were used to visually help youth understand the effects of ART on viral suppression rates. SeMRHI’s goals of this intervention included to improve youth outreach, especially to those who were not virally suppressed; identify barriers to care and make appropriate referrals; increase health literacy; manage mental and substance use issues affecting youth; and ensure consistent follow-up on missed appointments.

This intervention was successful in improving viral suppression rates for youth, defined as ages 13 through 24. Over a 12-month period from July 2018 to June 2019, viral suppression rates for youth increased from 58% to 78%. The viral suppression rates for youth continue to be sustained at rates at or above 75%. As of April 2021, the current viral suppression rate for youth ages 13-24 was 77%. As a result of this intervention’s success, it has now been implemented for patients of all ages, not exclusively for youth patients.

This is not to say that SeMRHI did not face any challenges along the way. COVID-19 brought about unprecedented barriers to the work they do. “COVID-19 really mirrors HIV,” reflected Tonya. “The treatment and the guidelines were constantly changing, just like when HIV came out. The greatest challenge was having to wrap our head around what is COVID-19 and how we can educate our patients on ongoing safety measures.” Through the pandemic, SeMRHI succeeded in introducing a virtual consumer advisory board and through this, they were able to provide patients with peer support and education about COVID-19.

Some words of wisdom Tonya gives for other providers is to find your niche. “If you could do something for free for the rest of your life that makes you happy, that is your passion,” emphasized Tonya. “My passion is in HIV care, and I really love what I do.”

Southeast Mississippi Rural Health Initiative, Inc. (SeMRHI)
Tonya Green, Director of Social Services
Email: [email protected] 
Phone: 601-582-2619

Leadership in Quality Improvement

Khalil Hassam, DC Health - HIV/AIDS, Hepatitis, STD and TB Administration, Washington, DC

We congratulate Khalil Hassam for his outstanding leadership in quality improvement (QI), and we are honored to present him with CQII’s 2021 Award for Leadership in Quality Improvement.

Over the past decade and a half, Khalil has been dedicated to quality improvement on the local, regional, and national level. In his current role as the Clinical Quality Improvement Specialist at DC Health, he has implemented effective and sustainable clinical quality management programs, innovative QI initiatives with measurable results that have benefited HIV clients and regional improvement efforts to work across a network of HIV organizations.

Khalil was the primary convener in bringing senior leaders together to replicate the long-term success of the DC Collaborative and the DC Eligible Metropolitan Area (EMA) Ryan White HIV/AIDS Program throughout the HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA). His work resulted in an organizational shift to advance clinical quality management infrastructures, including standardized QI curriculum for all new hires. Khalil was also the visionary of establishing a “culture of quality” in both DC Health and HAHSTA by embracing a middle-out approach that continues to inspire senior leaders, front-line staff, and persons with lived experiences receiving HIV services. He promoted the regional use of new QI methodologies and tools by making these concepts simpler and more accessible for all subrecipients with the EMA.

In his role as the DC Collaborative co-lead and the driving force behind the #DCALLCAPS end+disparities Collaborative team, Khalil helped improve health outcomes and lessened disparities among Transgender and Youth focus populations; see chart below. He designed a novel quality-driven business model, which combines grants with a value-based reimbursement model. With lean methodology as his driving force, Khalil led a Kaizen group to reduce complexity for subrecipients. Khalil was also a key quality leader in HAHSTA’s Rapid ART systems level change. He is a highly effective QI coach for his subrecipients and frequently uses games and simulations to encourage participation and problem-solving. He is able to optimize limited QI resources to their full potential, while also using his sphere of influence to advocate for additional quality resources. 

Khalil seeks to dismantle the notion that QI is overly structured. He encourages people to focus on the personal aspect of quality, not only to improve understanding of QI methodologies, but also to improve their own life. “Quality is about how you unload your dishwasher, it’s about how you send your emails, your commute to work, and so getting folks to think about quality as a way to enhance and better their own life is more digestible than ‘we’re all going to engage in this PDSA cycle so that we can reduce the grant monitoring time,’” said Khalil. He hopes to one day “work himself out of a job,” when a culture of quality is so ubiquitous that QI becomes obsolete.

When asked what lessons he learned at the start of his career that he still uses every day, Khalil replied “When you see an opportunity, go in, and produce, and create value. If you see an opportunity to improve something, don’t wait; step into the void and start making value wherever you can.”

Khalil Hassam 
Email: [email protected] 
Phone: 202-727-5659

Consumer Engagement in Quality Improvement

Reachelian Ellison, The Houston Regional HIV/AIDS Resource Group, Inc., Houston, Texas

We congratulate Reachelian Ellison for her outstanding work in consumer engagement, and we are honored to present her with CQII’s 2021 Award for Consumer Engagement in Quality Improvement.

As the Consumer Relations Coordinator at The Houston Regional HIV/AIDS Resource Group (TRG), located in Houston, Texas, Reachelian has revolutionized TRG’s ability to deliver quality care and enable services for people with HIV in and around Houston by implementing a Consumer Engagement Program, the Healthy U Initiative, and an “Education First” approach.

“Nobody wants to be in a one-sided relationship.” This is Reachelian’s mantra behind the restructuring of TRG’s consumer engagement program. Before Reachelian joined TRG, people with HIV were only engaged in one regional consumer advisory board. Reachelian implemented agency-specific consumer advisory boards (CABs) at every subrecipient and created a support structure that identified a CAB liaison and CAB chair who work in tandem to collect the experiences and concerns of people with HIV. Reachelian also helped split Houston Regional’s 51 counties into 4 regional CABs, which have been better suited to address the variety of consumers’ geographic areas and their needs. Reachelian conducts annual subrecipient consumer involvement monitoring visits and reports these results to the Ryan White Planning Council Quality Improvement Committee, local stakeholder agencies, and local consumer organizations.

Reachelian’s Consumer Engagement Program trained and supported people with HIV to become more actively involved in community stakeholder groups, as well as achieve their personal goals. Her program gave people with HIV the platform, resources, and support to become more empowered in seeking care and as advocates. Her Healthy U Initiative, based on the Experienced Based Co-Design Model (EBCD), calls on consumers (in collaboration with their clinical providers) to design educational materials for their peers for clinical sites. These deliverables helped improve patient compliance and information accessibility.

Reachelian’s “Education First” approach ensures that consumers know the purpose of any meeting they attend and what their role at the table is, which ensures consumers are equal partners in improving HIV care: “This has made a huge difference for me in being able to find consumers to participate, because then they’re not being called out to everything or things that they’re not interested in. It’s more of a focus on ‘what do you want me to call you about’ versus ‘there’s a meeting and we want warm bodies’,” said Reachelian.

Reachelian recognizes that each consumer brings their own unique experiences and abilities to the table by “meeting people where they are.” This allows for a relationship of trust and mutual enrichment between providers and consumers. Citing the diversity of the population of people with HIV, Reachelian understands that a one-size-fits-all approach to consumer engagement will not be successful: “There is a disconnect between staff seeing clients as having any real type of value to the agency beyond being a consumer. There needs to be more appreciation of the differences because a lot of the clients have skills that are overlooked or undervalued.” It is a testament to Reachelian’s stewardship that several consumers she has worked with have gone on to pursue higher degrees and higher positions within the CABs.  

Reachelian Ellison
Email: [email protected] 
Phone: 832-533-0743

Quality Award winners for 2019:

Measurable Improvements in HIV Care

Ryan White Wellness Center, Roper St. Francis Healthcare, Charleston, South Carolina

The Ryan White Wellness Center uses peer navigators to provide an additional level of support to clients that face challenges remaining in care and achieving viral suppression. The peer navigators began their work in early 2016. The navigators worked closely with the clinical case management team and administrative staff to create policies and procedures and develop peer-led strategies. Navigators provide various services to clients including: personalized reminder calls, follow-ups after visits, regular check-ins by telephone, and enhanced, peer-led treatment adherence counseling.

Over the course of the program the role of the navigators was expanded to include housing assistance, job readiness, and aging with HIV. At the inception of the peer navigation program the retention rate among clients referred to the program was 78 percent and the viral suppression rate was 47 percent. At the end of 2017, the viral suppression rate among those clients was at 77 percent and the retention rate was 94 percent.

Trillium Health, Rochester, New York

Trillium Health is an independent, neighborhood health center that has been providing comprehensive HIV care since 1989. Trillium made a concerted effort to reach out to individual not yet engaged in care. They launched a PrEP-Plus program that now has over 600 clients (one of the largest in New York State). While PrEP is not funded by Ryan White HIV/AIDS Program dollars, this outreach effort led to improvements throughout the patient population. The program started by identifying social group leaders and influencers to begin treatment and encourage people in their social and sexual networks to do the same.

These efforts were supported by an extensive marketing campaign using social media. This guerilla outreach/marketing team is made up of young men who have sex with men who conduct outreach at various venues and digital outreach using mobile phone dating apps. Using sound quality improvement methodology, they saw the need to improve the rates of the undiagnosed. Those individuals interested in beginning treatment were immediately linked to an intake specialist to facilitate the beginning of treatment. Before this guerilla market team was announced, Trillium patients were virally suppressed in 136 days on average.

This campaign led to patient's being virally suppressed in 58 days. To date, all newly diagnosed individuals identified by the guerilla/outreach team have begun antiretroviral treatment. Trillium attributes this success to their sex-positive approach and the trusting relationships built during outreach interactions. The team quickly discovered that they were identifying more undiagnosed HIV infection and acute HIV infection compared to Trillium's traditional, walk-in HIV testing.

Sustainable Clinical Quality Management Programs

Alabama Quality Management Group

Since 2006, Ryan White HIV/AIDS Program (RWHAP) recipients in Alabama have been meeting to share ideas on how to ensure optimal health for people living with HIV. The Alabama Quality Management Group (AQMG) initially included Part C and D recipients but over time, was expanded to also include Part B providers and now functions as a cross-Part collaboration. Members represent organizations providing services across the entire state-all 67 counties.

The group's priorities currently focus on 1) viral suppression; 2) retention in care; and 3) engaging new patients in care. The group assisted the Alabama Department of Public Health's Surveillance Branch with the implementation of the Data 2 Care Project. Data 2 Care assists RWHAP recipients in obtaining demographic data for clients who are truly out of care so that efforts can be focused on the re-engagement of those clients. In addition, the group is focusing on no show rates.

Members are collecting data on the percentage of patients who are a no show for at least one HIV-specific medical visit. This priority grew out of research conducted at the University of Alabama, Birmingham's 1917 Clinic showing that patients who missed visits within the first year after initiating treatment for HIV were at higher risk of dying than patients who attended all scheduled appointments. The group has secured funding for a statewide Data 4 Care intervention focused on reducing no-show rates. These activities will be initiated later this year.

Broward County EMA Ryan White Part A Clinical Quality Management (CQM) Program

The Fort Lauderdale/Broward County EMA established a system-wide quality assurance and continuous quality improvement program in 1997. A major project of the CQM program was the Consumer Health Experience Initiative (CHEI) to assess the quality of service delivery in the EMA by evaluating the client experience. A consultant gathered qualitative and quantitative data through a "secret shopper" experience at all subrecipients. Additionally, two educational modules to engage all subrecipient agencies and staff were conducted. Module One, "Creating a Welcoming and Responsive Service Environment for People Living with HIV," focused on identifying customer service themes of person-centered care, cultural humility, conscious and unconscious biases, and motivational interviewing.

Module Two, "Quality Initiative to Improve Customer Service and Care to People Living with HIV in Broward County Florida," aggregated mystery shopper/consumer experiences, identified facilitators/barriers to care, reviewed Module One evaluation data, and identified interventions to improve client engagement in services. Each agency received a final assessment of their results from the mystery shopper assessment, team culture survey, and Module One evaluation. In response to the findings, the CQM program is working to remove the barriers to care identified by the CHEI.

Leadership in Quality

Orange County Health Care Agency, 17th Street Testing, Treatment, and Care Clinic

The California Ryan White Part B Clinical Quality Management (CQM) program, in conjunction with the California Prevention Training Center (CAPTC), implemented a quality improvement pilot program to increase extragenital gonorrhea and chlamydia (GC/CT) screening in two high-volume Ryan White Part B clinics. One of the selected sites was Orange County Health Care Agency's 17th Street Testing, Treatment, and Care Clinic, a county public health clinic.

The primary goal of the pilot project was to improve sexually transmitted disease (STD) screening for men who have sex with men who are living with HIV. The clinic sought to increase extragenital screening by giving patients an option to self-collect swabs for pharyngeal and rectal gonorrhea and chlamydia. This option required the clinic to conduct a validation study for patient self-collected swabs. To ensure practice transformation, the clinic assigned a dedicated staff person to liaison with all stakeholders and staff. Patient input on self-collection procedures was obtained during the pilot project--patients were pleased with the new self-collection procedures.

The clinic is now in the process of finalizing and formalizing its new screening protocols, including configuration of the electronic medical record to allow electronic lab ordering and processing of patient-collected samples. Lessons learned from the implementation of this pilot have been valuable in framing how the California Department of Public Health will continue to support STD screenings for people living with HIV.

Marisa McLaughlin, Senior Specialist for Quality and Performance Improvement, Portland TGA

An example of Marisa McLaughlin's leadership has been her work to expand technical assistance provided by HIV Care Services (HCS) around the development of contractors' annual Clinical Quality Improvement (CQI) Plans. In response to needs expressed by contractors related to the CQI plans, Marisa developed and implemented an annual review of contractor performance measurement and quality management. The goal of this annual review is twofold, to assist with the development of CQI plans and to increase awareness and engagement in the review of programmatic data.

The reviews also solidify the role of HCS as a source of expertise, collaboration, and support to contractors to create sound evidence-informed quality goals. Marisa has also been leading the development of the Viral Suppression Support Project in the Portland-Multnomah County TGA. Obtaining viral load laboratory results from state surveillance is a new endeavor for the TGA. Marisa worked to ensure providers had clear direction for conducting outreach to clients that are not virally suppressed or are out of care. She ensured that people living with HIV were involved in the project. The discussions resulted in a draft work plan identifying which service providers would be first to reach out to clients and work with them toward viral suppression or stronger medical engagement.

Consumer Engagement in Quality Improvement

Neighborhood Health Services Corporation

To address sub-optimal medical appointment adherence (based on 2016 year-end statistics) the Neighborhood Health Services Corporation and its Early Intervention Program, in conjunction with its Consumer Advisory Board (CAB), designed and carried out a quality improvement project to address the sub-optimal adherence to appointment rates. The group committed to develop a quality improvement project based on this data to increase the adherence rate to 80%. They developed a tool to assess reasons for non-adherence, analyzed the results and then developed an improvement project using Plan-Do-Study-Act Cycles to test their interventions.

We congratulate the 2017 CQII Quality Award Winners:

Measurable Improvements in HIV Care

Maricopa County - Phoenix EMA

Phoenix/Maricopa County EMA Staff

RWHAP clients have far better HIV outcomes than those not getting Ryan White care, according to HRSA's client level RSR data system. The Maricopa (Phoenix) metropolitan area RWHAP Part A grant recipient is but one example, having achieved a 7% jump in viral suppression across the Eligible Metropolitan Area (EMA) grant coverage area. Maricopa's results are an outcome of multiple planning efforts and their application of various quality improvement resources, like the well-known PDSA cycle or the NQC Disparities Calculator that was used to identify population disparities to then develop staff and service needs in response.

Leadership in Quality

Linda Despines - University of Pittsburg Medical Center

Linda Despines - University of Pittsburg Medical Center

Sixteen years. Seemingly countless quality improvement projects. And a few handfuls of awards. Linda Despines has been a robust user of the HRSA HIV/AIDS Bureau's extensive quality improvement resources, from HAB's HIV performance measures to HIVQUAL to the CAREWare data software program as well as NQC's national technical assistance program. Despine also directed a project that realized a significant improvement in documented receipt of oral health care by HIV patients at PACT.

Consumer Engagement in Quality Improvement

Dawn Trotter - Evergreen Health Services

Dawn Trotter - Evergreen Health Services

There is no job title for Peer Extraordinaire. Yet. Dawn Trotter of Buffalo's Evergreen Health Services (real job title: Peer Retention Support Assistant) delivers peer services in her agency and somehow participates in numerous advisory boards focused on consumer involvement and quality improvement. All this and she got 30 HIV patients back in care over the last 6 months.

Randall Furrow Maricopa County - Phoenix EMA

Randall Furrow, Maricopa County - Phoenix EMA

Randall Furrow has worn, as they say, many hats during his time working on the Phoenix Ryan White planning council. He started as a member in 2004 and later became Chair, simultaneously working on enhancing consumer involvement in planning and quality improvement as well as more robust patient self-management.

We congratulate the 2016 CQII Quality Award Winners:

Measurable Improvements in HIV Care

Nationwide Childrens' Hospital; FACES Quality Improvement Committee

The Family AIDS Clinic and Education Services (FACES) program at Nationwide Children's Hospital is central Ohio's primary HIV clinic, serving more than 400 HIV-infected clients in more than 40 counties. The program's quality improvement committee (QIC) was recognized for their successful implementation of a "stoplight project" focused on increasing viral suppression. The project aimed to get as many clients as possible to an undetectable viral load (≤ 40) level. This target is much lower than the 200 copy/ml threshold required for HRSA reporting.

The QIC meets twice a month to review viral load data for each client, particularly those for clients in the "red light" category (load >1000 copies/ml) and clients with a viral load showing evidence of a loss of virologic control. Each client is discussed and individualized multidisciplinary care plans are developed.

Through a review of the patient population, the QIC identified three key drivers that prevented achievement of viral suppression-mental illness, non-compliance with medications, and failure to show up for appointments. Interventions were developed in response to each driver. For example, the interventions related to no shows included reminder calls to patients 48 hours prior to an appointment to make sure the client can arrange transportation with their insurance company and calls by peer navigators within 24-48 hours of a missed appointment.

Since the project was initiated in 2013, the viral suppression rates have increased significantly. In 2013, 68 percent of clients were suppressed. By 2015, 80 percent of clients were suppressed. Congratulations to the 2016 NQC Award for Measurable Improvements in HIV Care.

Family First Health: Caring Together Program

Family First Health is a community health center with five sites serving approximately 28,000 clients in South Central Pennsylvania. The Caring Together Program has been receiving RWHAP Part B and C funding since 1991 and serves approximately 550 clients.

In July 2014, Caring Together embarked on a 2-year quality improvement project focused on retention. Using the in+care Campaign's definition of medical visit frequency, in August 2014, data indicated a retention rate of 64 percent. Over a 2-year period, the program had seen a drop in medical visit frequency of 8.6 percent. The clinical quality management committee focused on using data to explore disparities and identify barriers to care. Several issues were found, including a glitch in CAREWare, process problems, and a disparity in the data for clients falling under 100 percent of poverty. After the CAREWare issue was resolved, the rate increased to 70 percent.

In response to the findings, processes were revised. The processes for refilling medications and completing lab work were streamlined and the process for reviewing out-of-care clients was improved. The CDC's Anti-Retroviral Treatment and Access to Services (ARTAS) intervention was also implemented. ARTAS is an individual-level, multi-session, time-limited intervention with the goal of linking recently diagnosed persons with HIV to medical care soon after receiving their positive test result.

As of January 2016, medical frequency measure is at 77 percent-an increase of over 12 percent from baseline data. Over the study period, viral load suppression rates also increased from 84 percent to 88 percent. Congratulations to the 2016 NQC Award for Measurable Improvements in HIV Care.