Introduction:As AIDS Arms, Inc. (AAI) increases the range and depth of its services, the Performance Improvement Committee has identified key projects to both maintain and improve the quality of those services. One of the quality improvement projects for the AAI medical/psychosocial case management programs is an internal quarterly Peer Review process. Although AAI has conducted this process since 2005, the data collection standards changed 1/1/2007 and the assessment considers the following three year period. The peer review is a quality assurance activity which compares 100% of progress notes and reported units of service against established standards. AAI’s main purposes for conducting the Peer Review are to:

1.ensure that all client files are appropriately documented

2.provide helpful feedback to staff members about their documentation (this is done through a structured review of their client hard files, service units and progress notes)

3.prepare the Agency for successful fiscal and programmatic audits The Peer Review offers an opportunity to identify problematic areas (such as missing eligibility documentation or progress notes not written to current standards) that would otherwise be discovered during either a supervisor’s case review or a funder’s audit. Through the Peer Review staff members are able to correct any identified problems in a timely manner and avoid audit citations.

Results:

The percentage of “Exceptions” tracked has decreased from 14% to 5% over the three year period.

The typical duration of the Agency’s fiscal and programmatic audits has decreased since implementation of the peer review process with less staff time required during the course of the audits.

Methods/Activities:The Peer Review offers a versatile and adaptable approach to help with decreasing the number of questioned items or “Exceptions” on a quarterly basis within AAI’s medical and psychosocial case management programs. Reported units of service and the associated progress notes were reviewed for the time period 1/1/2007 through 12/31/2009.

To decrease “Exception” rates, it is critical to develop a system to manage the process of the peer review. AAI’s training emphasizes that each reviewer who is participating in the process must work carefully and discreetly to review the work of another staff member while protecting that staff member’s confidentiality.

Training on the procedures and forms was conducted by the Quality Management staff members at the beginning of each quarterly review.

Contact Information:Eduardo Marez AS, Quality Monitor AIDS Arms, Inc.219 Sunset Avenue, Suite 116-ADallas, Texas 75208 Office: 214.521.5191, Fax 214.942.2297emarez@aidsarms.org

Lessons Learned:

A Peer Review process with effective procedures and ongoing training can be used successfully with medical case managers and psychosocial case managers to assure and improve quality by decreasing “Exception” rates.

Quality Assurance focuses on individuals and measuring compliance with standards. Quality Improvement (QI) focuses on systems and continuously improving system processes to meet standards. QI focuses on processes because most problems are found in processes, not in people.2 Better processes lead to better individual performance.

Actively engaging staff members and promoting their level of trust is critical to the success of quality improvement activities.2

Quality improvement thrives best in a working environment where the focus is on improving system performance rather than using the performance data for personnel performance evaluation.

References:1.National Quality Center, Training-of-Trainer Guide,

June 2007. 2. New York State Department of Health AIDS Institute, AIDS Education Training Centers National Resource Center, Measuring Clinical Performance: A Guide for HIV Health Care Providers, April 2002.

Peer ReviewQuarterly Volume of Records Reviewed

Example of a Peer Review Instrument

A RETROSPECTIVE ASSESSMENT OF PEER REVIEW PROCESS SHOWS IT HAS BEEN AN EFFECTIVE QUALITY ASSURANCE AND IMPROVEMENT ACTIVITY

Eduardo Marez AS, Del Wilson MA, Lauren Rogers, Jennifer Klein MSN, M. Keith Rawlings MD AIDS Arms, Inc.

Dallas, Texas