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Pender CHC STOP HIV Team

Pender CHC STOP HIV Team. Improvement. Developed case management for HIV + patients with identified “Gaps in Care” “Gaps in care” defined as no Primary visit or Viral load > 4/12, CD4 < 500 and not on ARVT and VL > 200 on ARVT >6/12

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Pender CHC STOP HIV Team

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  1. Pender CHC STOP HIV Team

  2. Improvement • Developed case management for HIV + patients with identified “Gaps in Care” • “Gaps in care” defined as no Primary visit or Viral load > 4/12, CD4 < 500 and not on ARVT and VL > 200 on ARVT >6/12 • Started process with PDSA in May/11 with new form for 1-3 case reviews/meeting. • Data showing improvement?

  3. Continuing Challenge • Keeping HIV registry updated and monthly reporting. • Patient Satisfaction Survey • Next Steps…..Need ongoing computer support from STOP Project Team. Need to improve process to include front staff for data entry. Will need revision of patient survey.

  4. Lessons Learned • Focus on computer skills • Positive impact of involving Outreach Team • Need to start measuring Numbers of Gaps in Care patients and impact of case management • Start developing plan for sustainability • Need ongoing work on self-management and patient involvement.

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