The facility-based or Organizational HIV Treatment Cascade was developed by the New York State Department of Health AIDS Institute as part of the HIV Quality of Care Program to integrate a public health approach with quality improvement initiatives at health care facilities. The power of the cascade as a visual tool to organize data that represent key outcomes of HIV care has been demonstrated through its widespread use throughout the world as part of approaches to control the HIV epidemic. The cascade, however, does not readily translate into performance data representing how care is provided at a healthcare facility. To facilitate a broader approach to monitoring the appropriateness of care provided to a population receiving services within a healthcare organization, the Organizational Treatment Cascade starts by including all people living with HIV who have received any service at that organization during the year. The organizational cascades are an integral part of achieving the second pillar of Governor Cuomo’s plan to end the epidemic by 2020, namely, to link and retain persons diagnosed with HIV in health care to maximize virus suppression so they remain healthy and prevent further transmission.
Explicit guidance was issued to define measures and the process for submission. As part of the AIDS Institute Quality of Care Program’s annual quality of care review, organizations submitted cascades for the 2016 calendar year for established and newly diagnosed patients, accompanied by a detailed description of the methodology used to obtain data to construct their cascades, and an improvement plan for addressing gaps in care identified in their cascade. Submissions were reviewed by QI coaches and ultimately approved by the Medical Director with feedback provided to organizations and requests for resubmissions as indicated.
The organizational HIV treatment cascades engage everyone at the organization, not just those working in the HIV program, in assuming responsibility for ensuring that PLWH who touch their healthcare system are engaged in HIV primary care. Quality improvement activities, based on identified gaps in the cascades, are now underway, as organizations will soon be getting ready to generate their next round of annual cascades.
See some of this year’s top submissions by visiting the ETE Dashboard’s Quality Corner!
Want to know more about Organizational HIV Treatment Cascades? Email QOCreviews@health.ny.gov