11

in+care CampaignUpdate for QAC

September 13, 2012

2

This in+care Campaign is designed to facilitate local, regional and state-level efforts to retain more HIV patients in care and to prevent HIV patients falling out of care while building and sustaining a community of learners among Ryan White providers.

33

CampaignParticipation

44

Nationally:474 HIV providers representing

401 HIV programs in 241 cities and across 46 States/Territories

have joined the Campaign so far

In NYS:47 HIV providers representing

40 HIV programs in 14 cities

55

caring for 425,444 people living with HIV

66

Updated August 27, 2012

77

Campaign Components

8

Campaign Components: Retention Data Submissions

• Performance Measurement• Submission of retention data every other month• 230 (57%) national participants have submitted• 22 (55%) NYS participants in have submitted

• Quality Improvement Projects• Monthly submission of Improvement Updates• 102 (25%) national participants have submitted• 10 (25%) NYS participants have submitted

8

9

Campaign Components: Quality Coaching

• Each participating site is assigned a Quality Coach• Provide feedback on all submissions including

retention data and improvement updates• Available to answer questions related to data

analysis and improvement project design

• NYS Coaches• Nanette Brey-Magnani (Western NY)• Johanna Buck (Central and Downstate NY)• 17 (43%) sites receive active coaching, 23 (57%)

sites have not taken advantage of coaching

9

10

Campaign Components: Webinar Curriculum

• Curriculum driven by enrollee demand / TA requests• Recorded versions of webinars saved on website• General Webinars (monthly)

• Includes national analyses of recent data• Topics include full range of institutional and social barriers to

patient retention in care and feature peer success stories• 9 programs held to date

• Meet the Author Journal Clubs (every other month)• Nationally renowned experts cover recent retention research• 5 programs held to date

10

11

Campaign Components: Local Quality Champions

• Volunteer role for Campaign participants• Create Local Retention Group Meetings• Establish a local community of learners • NQC provides resources to support Local Quality

Champions and Local Retention Groups

• 44 Local Quality Champions• 25 Local Retention Groups formed among them• Cover 33% of US territory and 70% of Campaign

enrollees

• NYS has three Local Retention Groups• Western NY (Anthony Jordan HC – Shawntrell Miles)• Central NY (Albany Medical College – Sootyeon Kwon)• Downstate NY (Bellevue Hospital – Jennifer Carmona)

11

12

Campaign Components: Partners in+care

• Consumer (and allies) track• Seeks to engage up to 1,000 consumers• Dedicated area of homepage contains special

resources and a toolbox for Partners in+care• Seeks to align consumer needs and input into broader

quality management dialogue on retention nationwide

• Custom Webinars• Content driven by enrollee demand (Facebook)• 4 programs to date

• Consumer Discussion Forums• Private Facebook Group (500 participants)• Listserv Group (160 participants)

12

1313

Campaign Performance and

Submitted Improvement

Strategies

1414

Snapshot Comparison – National and NYS Data

Campaign Data as of 09/10/2012

Dataset Dec Average

Dec Patients (Sites)

Feb Average

Feb Patients (Sites)

Apr Average

Apr Patients (Sites)

Jun Average

Jun Patients (Sites)

Aug Average

Aug Patients (Sites)

Measure 1: Gap Measure National 16.06% 123,498

(202) 16.25% 127,955 (195) 14.78% 125,661

(198) 15.30% 109,721 (174) 14.35% 100,773

(152)

NYS 11.74% 13,306 (19) 11.97% 13,288 (17) 11.78% 14,596 (17) 15.29% 14,464 (15) 10.85% 12.926 (13)

Measure 2: Visit Frequency Measure

National 64.12% 84,703 (153) 65.28% 85,336

(150) 61.77% 100,493 (172) 63.78% 88,589

(161) 63.76% 84,340 (145)

NYS 70.73% 7,998 (15) 69.93% 8,210

(13) 69.09% 8,417 71.21% 10,067 (13) 76.29% 8,879 (12)

Measure 3: New Patient Measure

National 56.92% 7,932 (192) 58.17% 8,736 (186) 58.69% 8,261 (189) 59.19% 6,939 (171) 59.81% 6,447 (152)

NYS 74.85% 843 (18) 75.41% 1,269

(16) 70.05% 1,035 (15) 67.58% 1,027

(14) 66.25% 877 (13)

Measure 4: Viral Suppression Measure

National 69.20% 133,916 (194) 69.40% 145,063

(187) 70.41% 148,975 (191) 71.81% 132,292

(174) 72.30% 118,711 (152)

NYS 67.18% 13,519 (20) 71.33% 12,740 (17) 71.85% 13,869 (17) 71.60% 13,400 (15) 75.31% 12,042 (13)

1515

Measure 1 – Gap Measure

1616

Measure 2 – Visit Frequency Measure

1717

Measure 3 – New Patients Measure

1818

Measure 4 – Viral Suppression Measure

19

NYS Improvement Update Submission Review

Interventions• Data Management and Sharing/Reporting

• Track no-shows• Track patients due for visit who have not come in yet• Record potential barriers to retention in EMR for each

patient

• Patient Contact• Reminder calls (what frequency, on what timeline?)• Immediate no-show/follow-up calls (on what timeline?)• Letters to patients who have not had a visit recently

• Patient Access• Travel tokens/passes/cards/vouchers (how many units?)• Co-location of services (how thing to stretch ourselves?)

20

NYS Improvement Update Submission Review

Interventions (continued)• Wrap-around Service Offerings

• Provide peer support opportunities for mental ill and substance users

• Treatment adherence counseling as part of each visit• Intensive care coordination services offered to high risk

individuals• Patient navigation services

• Patient Perks / Incentives• Patient greeters/concierges/registrars for patients to feel

important• Having food available for people to eat in waiting rooms• Distributing fast food coupons and other food cards• Child care services

21

NYS Improvement Update Submission Review

Lessons Learned• Appointment Keeping Behaviors

• Schedule for when patient says “yes, definitely” (not “will try to make it!”)

• Data Management• Record reasons why each patient misses visits and analyze

aggregates• Understanding your patient demographics

• Operational Management• Flow-sheets help the team to understand patient experience and

opportunities for process/procedural improvement

• Patient Comprehension• Established care teams help patients feel at home and they will

know whom to contact with questions or when in distress

22

NYS Improvement Update Submission Review

Lessons Learned (continued)• Team Efforts

• Engage all staff in discussing improvement• Engage consumer focus groups (CABs) to discuss

improvement• Discuss retention among provider agencies within

the community

2323

Time for Questions and Answers

2424

• Campaign Office Hours:Mondays & Wednesdays 4pm-5pm ET

• Improvement Update Submission Deadline: September 17, 2012, 5pm PT

• Next Partners in+care: Reaching Out to Keep Our Friends in Care September 18, 2012, 4pm ET

• Next Meet the Author: IAPAC Retention GuidelinesSeptember 19, 2012, 2pm ET

• Campaign Webinar: Identifying Patients at Risk for Falling Out of Care September 25, 2012 3pm ET

• Data Collection Submission Deadline:October 1, 2012, 5pm PT

Upcoming Events and Deadlines – Join Us!

2525

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

incareCampaign.orgyoutube.com/incareCampaign