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QM Plan Template 8 11 09 by v5rXH5

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									Directions: Below is the RWP template for each Part A subcontracted agency to utilize to develop an agency-specific Quality
Management (QM) Plan. The sections in bold identify categories of the QM plan that each agency-specific plan should
include. Please fill-in the blanks with the requested information (and the information in brackets provides guidance on the
information that should be included in each blank). By developing a plan in accordance with the template, the agency will
be in compliance with the RWP contract requirement of having an agency-specific QM plan.



                                              ________________________
                                                    [AGENCY NAME]
                                               Quality Management Plan
                                                   ______________
                                                  [Date Implemented]

        ________________
        [EFFECTIVE DATES]

            I.   Quality Statement

                    The purpose of this plan is to set forth a coordinated approach to addressing quality
                    assessment and process improvement at ____________________________ [agency name].
                    The program has established as its mission _______________________________________
                    ___________________________________________________________________________
                    ___________________________________________________________________________
                    ___________________________________________________________________________
                    [Insert mission statement, i.e. provide a brief purpose describing the end goal of the HIV
                    quality program. The mission statement should answer the question, “ What does your
                    agency want for your HIV/AIDS patients?”]

            II. Quality Infrastructure

                    A. QM Team and Responsibilities
                       The agency’s QM team is accountable, responsible and answerable for planning,
                       directing, coordinating and improving healthcare and support services in the HIV
                       Program. The QM Team includes ____________________________________________
                       _______________________________________________________________________
                       _______________________________________________________________________.
                       [List staff and title of individuals on the QM Team, including their responsibilities]

                    B. Quality Committee/Meetings
                       The QM Team approves the performance improvement plan, and reviews quality
                       improvement activities during its regular meetings. Meetings are held ______________
                       _______________________________________________________________________.
                       [Identify the frequency of meetings]



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       C. QM Program Content
          The program is designed to address quality regarding the following major services:

            1. ________________
            2. ________________
            3. ________________
               [List the services funded through your Part A grant. Add additional services lines if
               needed.]



III. Annual Quality Goals

       The following goals address an agency-wide process for planning, designing, measuring,
       assessing and improving performance

       A.   TGA Goal 1: [insert]
       B.   TGA Goal 2: [insert]
       C.   TGA Goal 3: [insert]
       D.   TGA Goal 4: [insert]
       E.   TGA Goal 5: [insert]
       F.   Agency Goal: [Insert]

       [Includes the TGA-wide annual quality goals and at least 1 agency-specific goal. These goals
       are endpoints toward which the agency’s QM program will direct its efforts and resources.]

IV. Performance Measurement

       The selection of performance measures is based on the major functional areas and the
       important aspects of care and service provided by the agency. The performance measures
       include:

       A.   TGA Indicator (if applicable)
       B.   TGA Indicator (if applicable)
       C.   TGA Indicator (if applicable)
       D.   TGA Indicator (If applicable)
       E.   TGA Indicator (if applicable)
       F.   Agency Indicator
       G.   Agency Indicator
       H.   Agency Indicator




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             [Includes the TGA-wide indicators that are relevant for the agency and at least 3 agency-
             specific indictors that will aid the agency in meeting the annual quality goals indentified in
             section III.]

             Regular review of data for performance measures will occur ___________________
             [frequency of data extraction] by extracting data from CAREWare. The agency’s QM Team
             will review these data reports at the regularly scheduled QM meetings. ________________
             [designated staff person] will ensure that data is inputted into CAREWare for the TGA QM
             Lead to review the TGA Indicators at the time specified by the TGA QM Lead.

    V. Evaluation and Assessment

             A. QI Activities:
                The agency will conduct at least 2 Quality Improvement (QI) activities per grant year.
                These will be identified based on low performance on measures indentified in Section
                IV.

             B. Agency-Specific Performance Measures:
                On a semi-annual basis, the agency will review if selected performance measures are
                appropriate for the agency to track.

             C.   QM Infrastructure:
                  On an annual basis, the agency will review the structure of the QM and identify areas
                  where more resources should be allocated.

             D. Annual Update:
                The agency-specific QM plan will be updated annually during the month of ________.
                [insert month]

             E. Communication:
                Activities conducted by the QM Team will be reported to the appropriate inter- and
                intra-stakeholders at the relevant times.


Signatures

        __________________________________________                               _________________
        [Name, Title]                                                               Date

        ____________________________________________                               _________________
        [Name], Ryan White Contract Coordinator                                    Date

        ___________________________________________                                _________________
        [Name], Ryan White Program QM Lead                                          Date

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