Campaign Webinar State Approaches to New Patient Retention December 4, 2013

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Campaign WebinarState Approaches to New Patient Retention

December 4, 2013

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Ground Rules for Webinar Participation

• Actively participate and write your questions into the chat area during the presentation(s)

• Do not put us on hold• Mute your line if you are not speaking (press *6, to

unmute your line press #6)• Slides and other resources are available on our

website at incareCampaign.org• All webinars are being recorded

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Agenda

1. Welcome & Introductions, 5min2. Campaign Update, 10min3. Ohio Part B Program, 40min4. Announcements, 5min

In the chat room, Enter your:

1. name, 2. agency, 3. city/state, and 4. professional role at agency

Michael Hager, MPH MA NQC Manager,in+care Campaign ManagerNew York, NY

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Campaign Update

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in+care Campaign in 2014• Campaign database running through 2018!• Campaign website running through 2018!• Partners in+care Facebook maintained indefinitely• Campaign Newsletter moves to quarterly• Campaign Webinars move to quarterly• Partners in+care Webinars move to quarterly• Campaign Coaching integrates into NQC

Continuous TA Portfolios• Local Retention Groups that wish to continue

meeting should do so – NQC will support where possible

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2013-2014 in+care Campaign Activities

2013 2014

Activities JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

1-Campaign Webinar 2-Journal Club Webinar 3-Campaign Data Reporting Cycle by Participants

4-Availability of Database Benchmark Function

5-Improvement Strategy Cycle 6-in+care Website and Posting of Updates

7-Campaign Newsletter 8-Partners Webinar 9-Partners in+care Facebook 10-Campaign Coaching Availability

11-Local Retention Group Availability

12-Case Study Drafting 13-Final Report Drafting 14-Communications with participants around transition

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Submit Improvement Updates!

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Disseminating Improvement Work

Lightning Rounds!• 1 or 2 slides that contain the most salient points of your

retention projects• Include information on patient target, rationale for target selection and

baseline data from your measures (including the date)• Include information on each improvement cycle (what was tried, what

was the result per the data) – for early cycles short measures of change are not necessary, but add value!

• What are your conclusions? How are you sustaining improvement

• Simplicity and clarity are the idea!

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Disseminating Improvement Work

Case Studies• Help us tell your story!

• Campaign coaches are seeking longer, written stories about various groups’ journey through the in+care Campaign

• Contact your Campaign quality coach if you are interested in sharing your story!

• We are collecting 12 stories in total for publication

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Gap Measure Results (12/11 – 12/13)

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Visit Frequency Measure Results (12/11 – 12/13)

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New Patients Measure Results (12/11 – 12/13)

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Viral Load Suppression Measure Results (12/11 – 12/13)

LINKAGE FROM HIV TESTING TO HIV CARE

Definition Linkage: The process of connecting

a client from one service system to another, in this case from HIV testing to HIV care.

LTC = Linkage To Care

Why is this important? Reduce HIV transmission by connecting newly

diagnosed individuals to medical care as soon as possible after diagnosis; and

Connect more PLWHA with HIV-related medical and support services to improve their health; and

Facilitate a coordinated system of services from HIV prevention and testing to HIV care.

Systems Involved in Providing Linkage

PREVENTION CARE HIV CTR sites ODH HIV Prevention

Program HIV case management

agencies ODH HIV Care Services

HIV expanded testing sites

ODH HIV Prevention Program

Ryan White Emergency Financial Assistance Program

ODH HIV Care Services

Partner Services

ODH STD & HIV Prevention Programs

Ohio HIV Drug Assistance Program (OHDAP)

ODH HIV Care Services

Ohio HIV/STD Hotline

ODH HIV Prevention Program

Measure of Successful Linkage 90% of persons testing HIV+ will be referred to

LTC.

80% will be linked to medical care within 90 days of testing positive.

Successful linkage from testing to medical care is defined by the client attending the initial visit at a medical setting with a HIV care provider.

Polling Question!What proportion of your newly diagnosed people with HIV are linked to care?

0%-25% 26%-50% 51%-75% 76%-100% I’m not sure

Polling Question!What percentage of your clients who are linked to HIV care are retained in care (2 or more visits in the first year after linkage)?

0%-25% 26%-50% 51%-75% 76%-100% I’m not sure

Linkage Roles & Responsibilities HIV Test Counselor

Disease Intervention Specialist

HIV Prevention LTC Coordinator

Staff at HIV Care Agency

LTC Client Pathway

LARHCLinkage and Re-Engagement in HIV Care

How are we going to capture all these LTC activities?

Overview of systems involved The project will work with 3 existing

systems, eHARS, CareWare and ODRS.

eHARS CareWare ODRSPatientPatient Patient

Goals of LARHC To have a registry of everyone living with HIV to

provide Linkage to Care And Re-Engagement in Care Services.

To have a place to store data related to LARHC.

Have the ability to create reports from unified data.

Store new information related to patient/case.

Solution 1 for LARHC Extract information from CareWare and

eHARS, merge into ODRS and view consolidated info using ODRS GUI

eHARS

CareWare

ODRSODRS GUI

Pros/Cons of Solution 1PROS: Creates a central datastore for all information from

eHARS and CareWare. Information can be viewed using existing ODRS GUI.

CONS: Complicated ODRS system. Introducing new functionality into ODRS might create

new issues. Information is not current (eHARS, CareWare).

Solution 2 for LARHC Create a new subcomponent in ODRS

called LARHC and provide views into eHARS and CareWare.

eHARS

CareWare

view

view

ODRS system LARHC

Pros/Cons of Solution 2PROS: Provides views into external eHARS and CareWare

systems. Information can be viewed using existing ODRS GUI.

CONS: Complicated ODRS system. Introducing new functionality into ODRS might

create new issues.

Solution 3 for LARHC Create a new application independent of

ODRS that can satisfy all the needs of LARHC.

eHARS CareWare ODRS

LARHC GUILARHC

viewviewview

Pros/Cons of Solution 3PROS: Creates real time views into external systems. Does not involve extraction/transformation/loading

external data into ODRS. Provides ability to report data from various disparate

systems for reporting purposes. Allows Care Management specific information to be stored.

CONS: Dependent on external systems to show data.

Components of Solution 3

LARHC

Mapping

Query / Search

ReportingAdministration

Care Management

Challenges LTC coordinators in place before

protocols / IT system

Distinction between role of LTC coordinator, DIS and case manager

Patient confidentiality for long-term follow-up

Successes During first six months of 2013, 94.5% (411/435) of newly

identified, confirmed HIV-positive clients were referred to medical care.

During first six months of 2013, 64.6% (281/435) of newly identified, confirmed HIV-positive clients attended their first medical care appointment within 90 days of the confirmed HIV-positive test date.

HIV/STD Prevention, HIV Care, and HIV/STD Surveillance programs working collaboratively.

Special Thanks Elizabeth Cross – ODH HIV, STD, TB & Hepatitis

Surveillance Program Administrator

ODH HIV & STD surveillance epidemiologists

ODH HIV Care staff

Local health department staff

ODH Office of Management Information Systems staff

Contact InformationJen Keagy, MPH, CHES

HIV/STD Prevention Program Administrator 466-3173

Jen.Keagy@odh.ohio.gov

Jill GarrattHIV Prevention Monitoring & Evaluation Coordinator

728-0877 Jillian.Garratt@odh.ohio.gov

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Announcements

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Upcoming Webinars: ― Partners in+care Webinar | SPNS Projects Examine

Retention in+care for HIV-Infected Transgender IndividualsThursday, December 10, 2013 | 2pm ET

Data Collection Submission Deadline: February 3, 2014

Improvement Update Submission Deadline: December 16, 2013

December, 2013 Campaign TopicDigital Health and Retention in+care

Upcoming Events and Deadlines

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Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floorNew York, NY 10007Phone 212-417-4730incare@NationalQualityCenter.org

incareCampaign.orgyoutube.com/incareCampaign