HRSA HIV/AIDS Bureau Special Projects of National Significance Systems Linkages and Access to Care for Populations at High Risk for HIV Infection in New York State June 12, 2012
Welcome and Updates Bruce Agins, MD,MPH Gregory Young, MD FACEP Andrew Doniger, MD,MPH Gale Burstein, MD, MPH Monica Sweeney, MD, MPH Katherine Godesky, MPH, MSW
Bruce Agins, MD, MPH Linkage, Retention, and Quality Improvement
Nanette Brey Magnani Group introductions and review of group’s expectations
Clemens Steinbock, MBA What is spns?What is the wnys collaborative?
What are ‘SPNS’? • Special Projects of National Significance • Part of the Ryan White HIV/AIDS Program and administered by the HRSA HIV/AIDS Bureau • Aims to support the development of innovative models of HIV care that respond to emerging needs of Ryan White clients • Topics for SPNS funding prioritized by HRSA • Strong evaluation/research component to assess the effectiveness of models, and then focus on the dissemination and replication of successes at a national level
SPNS Initiative – Systems, Linkages andAccess to Care • Development of innovative and sustainable systemic models of linkage to improve access to and retention in quality HIV care • Alignment of different components of the public health system, such as surveillance, counseling/testing, emergency rooms, mental health/substance use clinics, correctional health-care facilities (traditional and non-traditional providers) • Alignment with National HIV/AIDS Strategy Goals: • Reduce number of people who become infected w/HIV • Increasing access to care and optimizing health outcomes • Reducing HIV related health disparities
Engagement in Care Continuum Non-Engager Sporadic User Fully Engaged  Health Resources and Services Administration, HAB. August 2006. Outreach: Engaging People in HIV Care Summary of a HRSA/HAB 2005 Consultation on Linking PLWH Into Care.  Eldred L, Malitz F. Introduction [to the supplemental issue on the HRSA SPNS Outreach Initiative]. AIDS Patient Care STDS 2007; 21(Suppl 1):S1–S2.
SPNS Initiative – Systems, Linkages andAccess to Care • 4-year funding cycle awarded to high incidence states • Adapted approach of the Collaborative Model developed by the Institute for Healthcare Improvement (IHI) • Development of grantee-specific evaluation strategies to identify and document successful models • Comprehensive multi-state evaluation led by a national evaluation center (UCSF – Janet Myers)
SPNS Initiative – Systems, Linkages andAccess to Care • Overall goals for this initiative, consistent with National HIV/AIDS Strategy, are to: • increase the number of individuals who know their serostatus • increase the number of newly diagnosed linked to HIV care within three months of diagnosis • increase the number of individuals who are virally suppressed • increase the number of people living with HIV retained continuously in quality HIV care
SPNS Initiative – Systems, Linkages, andAccess to Care • Timetable • RFA Announcement: March 2, 2011 • Grant Application: April 4, 2011 • Initiation of SPNS Grant: September 1, 2011; October, 2011; and WNY, June, 2012 • End of SPNS Grant: August 31, 2015 • SPNS Awardees: • New York • Louisiana • Massachusetts • North Carolina • Pennsylvania • Virginia • Wisconsin
Together, WE identify innovative solutions for improving linkage to and retention in HIV care to support the delivery of routine, timely, and effective care for PLWHA in New York State; and bridge systemic gaps between HIV related services to achieve better outcomes for PLWHA through improving systems for monitoring, recording, and accessing information about HIV care in NYS. NY Links Mission
Timeline Collaborative Waves Statewide Dissemination Data and Systems Integration SPNS Evaluation Year 1 Year 2 Year 3 Year 4 • Years 1 & 2 Collaborative Waves • Wave I: Upper Manhattan Regional Group and Western NYS • Wave II: 2 Collaboratives in NYC • Wave III: 2 Upstate Collaboratives • Years 3 & 4 Statewide Dissemination • Identification of Successful Linkage/Retention Interventions • Statewide Conference(s) to Promote Successful Interventions • Webinars, Conference Calls, etc. • Posting on AIDS Institute and other QI Websites
Data Subcommittee Purpose: • to identify and address key issues and to effectively utilize already available data sets (epi/surveillance, Medicaid, AIRS, etc.) to improve linkage/retention • to make these data sets accessible to frontline providers for quality improvement efforts Major Participants: • Denis Nash (lead) & Dr. Bruce Agins • Dennis Tsui (Medicaid) • Dr. Colin Shephard (NYCDOHMH Epi & Surveillance) • Mary Irvine (NYCDOHMH E-Share) • John Fuller (NYSDOH AIRS) • Dr. Lou Smith & Dan Gordon (NYSDOH Epi & Surveillance) • Eli Camhi (Metroplus) • Tom Moore (Healthix)
Upper Manhattan Regional Group • Engagement of all medical and non-medical providers in the Upper Manhattan geographic area to improve linkage to and retention in HIV care (31 sites) • Current Progress: • 3rd Learning Session: April 10th , 2012 • 1st Collection of Collaborative Measures: April 2nd, 2012 • 2 QI Workshops modified for linkage and retention have been held • Next Steps: • Test and evaluate provider-driven interventions • Provide data measures technical assistance • Blue-Clinical Program Participating in the Upper Manhattan Regional Group • Yellow-Supportive Service Program Participating in Upper Manhattan Regional Group
Western New York State • Engagement of all HIV medical and non-medical providers in the Western NY geographic area (Rochester and Buffalo) to improve linkage to and retention in HIV care • Current Progress: • Support and involvement of Erie and Monroe County DOH • List of participating providers developed • Planning Group developed • Next Steps: • 1st Collaborative Meeting: June 12 • Continue to conduct initial introductory Site Visits
WNY Collaborative Teams by Zip Codes • Red-Clinical Programs Participating in the WNYS Regional Collaborative As of April 26, 3012
WNY Collaborative Model and Dates June 12 F2F
Nanette Brey Magnani Small group work:building a system to link and retain patients
Building a System to Link and Retain • Overview: • To visually create a system and its sub systems that depict organizational relationships that link patients to care within each region of Western NY – Buffalo area and Rochester area. • The diagrams will illustrate: • the strength of organizational relationships (none to strong). • linking and retaining patients in care • Uses: Over time, • identify strengths, weaknesses, and opportunities for improvement (system, sub-systems) • peer exchange • identifying needs for TA and content and methodology for regional workshops
Part 1 • 30 minutes • Each agency writes its name on a circle. If there are several departments within an agency, the department(s) can write its name on each of the designated color circle. • Each agency goes up to the flip chart and tapes its circle(s) on the flip chart paper. • Draw a blue arrow connecting your agency to those agencies that you have a linkage and retention relationship with, ie, protocols in place, frequent referrals and follow up. An arrow in one direction means the communication is essentially in one direction. An arrow that goes in both directions means there is communication and feedback re patients referred, linked and documented. • Draw a green line to those agencies that you have a more informal relationship with and less frequent referrals. • If you work with an agency that is not here, add its name to a circle and tape it to the diagram. • Write down questions, circumstances that fall outside of these directions.
Part 2 • 20 minutes • For those agencies (departments) that you have a blue line, write down your strategies or what you do to refer and link patients to care. • For agencies (departments) that provide primary care, write in your circle or next to it, what strategies you use to retain patients in care.
Part 3 • 10 min • Large group exchange: • Share your experience and observations in creating the diagram. Were there new insights? To what degree was there agreement? • What are some of your system’s strengths? sub-systems strengths? • Are there opportunities to strengthen your system? Sub-system? • What can you observe about your strategies for linking or retaining patients?
Clemens Steinbock Working lunchintroduction to response team
Collaborative Response Team A Collaborative Response Team is a self-organizing, peer-driven group made up of 5-10 nominated leaders with complementary skill sets and roles from among each NYS Collaborative membership. Purpose: Streamline communication across teams Strengthen leadership capacity in the Collaborative Support & direct Collaborative activities Increase sustainability beyond the Collaborative 30
Response Team Members Wanted! Expectations: Conduct regular team meetings Share information routinely with collaborative body Participate in Collaborative planning efforts Report back on collaborative progress to constituents Support collaborative members in QI competency Membership: Cross-agency & cross-provider category Reflects various functional skill needs of the Collaborative Composition and core roles flexible based on needs of the Collaborative Membership determined by Collaborative participants 31
Dan Gordon, PHD Epidemiology Data and its relevance to WNYS
Clemens Steinbock Small group work:measures, collection, submission
Small Group Instructions: 20 minutes • Take out information on performance measures in your packets. • Select a group facilitator. • Beginning with the first measure, have a volunteer from your group explain the first Linkage to Care measure for agencies that do HIV Testing. • Repeat with volunteers for 2a and then 2b; then 3a and then 3b. • There is a resource person at each table to answer questions and provide additional explanation if needed.
6. Small Group Report Out • List questions/concerns on a flip chart paper that could not be addressed in your group. • 7. Large Group Exchange • Report out from each group. • Questions for large group discussion.
To the extent possible, integrate data collection into current approach - e.g. modify intake and referral forms to include questions then enter • onto a tracking form • into an EMR, e.g., AIDS Care and Evergreen use • EMD • Excel spreadsheet – e.g. for Supportive • Services (in your packet) • AIRS Data Collection
Small Group Instructions: 20 minutes. • Take out information on pre-work and data elements in your packets. This is the same or similar information that was reviewed during pre-work webinars and during some site visits. • Select a group facilitator. • Review each measure and take notes on flip chart paper. • Tool 1: HIV Testing – Understood, able to collect data; identify issues, concerns, questions. • Tool 2a. Primary Care Global Retention – repeat…. • Tool 2b. Primary Care New Patient Retention – repeat… • Tool 3a. Clinical Engagement – repeat... • Tool 3b. New Client Clinical Engagement – repeat… • Resource people are with your group to assist.
Small Group Report Out: 5 minutes • Ask for a different volunteer to share results of group’s discussion. • Large group discussion on issues needing resolution.
Performance Measurement Reporting Expectations • Self reporting of NY Links measures every 2 months • Submission of performance measurement data to NY Links online data basis (www.newyorklinks.org/database) • Sharing of improvement activities
Access to NY Links Database: NewYorkLinks.org/database/ • Online application allows agencies to self-report their performance data • Immediate access • to individual scores trended over time • to benchmarking reports • to reports based on common search criteria