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Regional Group Spotlight: Involving Consumers Meaningfully in Quality Improvement in the West
West Overview

Consumer involvement, which facilitates direct participation and identification of consumer priorities for healthcare programs is a key component to quality improvement activities.  How consumer involvement is implemented within a clinic varies widely.  Approaches may include:

- consumers acting as members of a clinic’s quality improvement (QI) committee/teams; 
- consumers reviewing clinical performance data and QI activities; 
- the clinic establishing a consumer advisory board (CAB) that discusses quality of services provided; 
- clinic staff assessing consumer needs and satisfaction, with the results then integrated into future QI activities.
Several HIVQUAL-US-participating clinics in the Western states have developed innovative and meaningful opportunities for consumers to contribute towards the successful delivery of care to HIV-positive patients.
Mendocino Community Health Clinic (MCHC)’s HIV/AIDS program has provided access to healthcare and case management services since 1993. Serving 224 HIV-positive patients in 2011 across four different sites in northern California, MCHC is also a member of the Mendocino/Sonoma HIVQUAL-US Regional Group.  MCHC hosts two CABs (one in each county) to accommodate consumers travel across a large rural area.  Anne McAfee, Ryan White Program Coordinator, describes CAB meetings as an opportunity for consumers to: discuss living with HIV; receive educational information regarding medications, lab values, and standards of care; review the MCHC quality plan; and study the quarterly clinical performance data.  Outside of the CAB, two consumers serve as representatives to the HIV Quality Team and clinic-wide board of directors.
CAB members at Harborview Medical Center’s Madison Clinic in Seattle, Washington, have also assisted in the planning and facilitation of annual World AIDS Day events as well as a public health media campaign encouraging consumers to “know your [viral load and CD4 count] score.” 
The Multnomah County Health Department’s HIV Health Services Center (HHSC) and University of San Diego - Owen Clinic, participants in the Pacific Virtual and San Diego HIVQUAL-US Regional Groups respectively, have implemented novel strategies to better engage more consumers in CABs and other QI activities.  Located in Portland, Oregon, HHSC has begun to host CAB “open houses” as a time in which consumers might meet with current members and as an opportunity to recruit new members.  This, in combination with efforts by HHSC to keep CAB participants up-to-date on emerging quality of care issues, has helped to strengthen consumer buy-in.  Meanwhile, UCSD - Owen Clinic has found scheduling CAB meetings during lunchtime while providing complimentary refreshments and free parking to be the best ways to improve consistent attendance.  A larger number of regular attendees allows for a CAB membership that is more representative of the overall clinic population and therefore provides more meaningful insights to be incorporated within the overall quality management activities.
Both facilities have seen an increase in consumers’ impact upon and ownership of QI-related initiatives.  Since 2010, HHSC’s and UCSD - Owen Clinic’s CABs were each instrumental in the establishment of open-access hours, the clinic-lobby-redesign as a more “patient-friendly” space, and the implementation of MyChart (an electronic health record system that allows patients to view lab test results, communicate directly with the provider and/or submit prescription refill requests).  Furthermore, Owen Clinic’s CAB requested and assisted in the development of restrictions on clinic waiting room TV channels and the installation of additional monitors that provided patients with up-to-date health-related information.
Many clinics have found consumer input in the planning and implementation of specific QI projects to be critical for their effectiveness.  Dr. Shireesha Dhanireddy, member of the HIVQUAL-US Clinical Advisory Committee and Assistant Medical Director to Harborview Medical Center’s Madison Clinic, routinely presents to the CAB regarding progress in raising rates for cervical Pap tests, lipid screening, CD4/viral load monitoring, and Hepatitis A/B immunization.  Dr. Dhandireddy then solicits consumers’ feedback and advice in order to better address any outstanding barriers to improved health outcomes.
Maricopa Integrated Health System (MIHS) - McDowell Healthcare Center has functioned as the HIV specialty clinic within MIHS since 1989, providing primary medical care, dental care, HIV testing and counseling, and behavioral health care to 2,590 patients in 2011 (2,241 patients for medical services only).  As an Arizona HIVQUAL-US RG participant, MIHS has expanded the role of consumers to include working as integral members of the clinic staff and the QI committee.  In particular, Ryan White Part D Family Advocate and consumer, Lorraine Brown, has been key to effective interventions employed during various QI projects initiated since 2004 as a full-time staff member (as illustrated in figures shown above and below).
As part of the effort to improve rates for tuberculosis (TB) screening as well as pelvic examinations and Pap tests for female patients, Lorraine has been responsible for two major strategies. (1) She develops and distributes a weekly electronic newsletter to more than two-thousand patients and other subscribers, alerting patients to clinic updates and emerging quality of care priorities.  This has allowed  MIHS staff to emphasize the importance of the QI committee’s goals for improvement to the larger consumer community.  (2) Lorraine and a second staff member complete all reminder phone calls to patients with upcoming clinical visits.  At the time of the call, they will note any treatment or screenings a patient is due for while also answering questions and/or responding to concerns he or she might have.  
Thanks to her positive rapport with patients, Lorraine is able to address any lingering misconceptions or discover barriers that may prevent an individual from accessing care.  This approach has been expanded and applied to each successive QI project with great success (as shown in chart below) and has been systematized as a routine step in the overall clinic flow.  Since 2010, MIHS has focused on decreasing rates of visit “no-shows” or missed appointments, using many of the same strategies.  As of September 2011, the facility has reached a “no-show” rate of 19%, down from 27% in 2009.
Consumer involvement continues to generate significant positive impact upon clinical care delivery at each of these organizations.  The insights and efforts provided by consumers are crucial components to quality improvement.


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