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in+care Newsletter  Oct 2011 Issue 1  


National Campaign to Improve Retention in HIV Care  
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In This Issue
Technical Working Group Convenes
Journal Spotlight
Upcoming Events
Case Study: One Ryan White Grantee's Story
Campaign Updates
Number of providers and sub-providers that have joined the campaign:
Number of HIV patients served by participating providers (not unduplicated):
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Technical Working Group Convenes

The in+care Campaign's Technical Working Group, comprised of distinguished experts in the field of retention, met on October 5th in Rockville, MD to discuss the selection of retention in care performance measures. Dr. Laura Cheever, Chief Medical Officer and Deputy Associate Administrator of the HIV/AIDS Bureau, and Dr. Bruce Agins, Medical Director of the New York State Department of Health AIDS Institute, chaired this expert group.


The purpose of the meeting was to advise the HIV/AIDS Bureau and NQC on the Campaign performance measures to effectively assess retention in HIV care and track performance over time throughout this national quality improvement initiative. The meeting brought together clinical and quality management experts from around the country, where they reviewed recent retention publications and current performance measures, discussed their own activities related to retention, and prioritized retention measures. Final selection of the Campaign measures will be announced within the coming weeks. Stay tuned.


Upcoming Events  


Kick-Off Webinar: Performance Measures and Collecting Data 

Wednesday, October 26 at 1 pm EST


Connect to the webinars with the following information:  

URL: http://www.nqcqualityacademy.org/incarecampaign 

Dial-in#: 866.394.2346
Participant Code: 7843936569#  

Journal Spotlight: "Retention in Care: A Challenge to Survival with HIV Infection"

Giordano TP, Gifford AL, White Jr. AC, Suarez-Almazor ME, Rabeneck L, Hartman C, Backus LI, Mole LA, and Morgan RO, "Retention in Care: A Challenge to Survival with HIV Infection", Clinical Infections Diseases 2007; 44: 1493-1499.


In this retrospective cohort study published in 2007, Giordano et al. seek to quantify the relationship between poor retention in care and survival rates. Researchers examined newly identified HIV patients starting ART across all hospitals and clinics run by the United States Department of Veterans Affairs. The researchers examined the clinical outcomes from 2,619 male patients, who survived at least one year and kept at least one visit per year over the subsequent four years, and noted their CD4 counts and plasma HIV levels. These measurements were compared to the number of primary care visits each patient had over the period of a year. The patients were divided into four groups based upon whether they kept at least one visit per quarter each year. Over the four year period, 64% of the subjects had visits in each of the 4 quarters, 18% had visits in 3 of the 4 quarters, 11% had visits in 2 of the 4 quarters, and 6% had visits in only 1 of the 4 quarters. Giordano et al. found after looking at the CD4 counts, HIV plasma, and survival rates that poor retention in care was associated with fewer improvements in CD4 cells and less reduction in plasma HIV levels. It was found that those who had only one visit a year had the worst survival rates, while patients who kept an appointment in each quarter of the year had the best survival rates. In fact, the survival reduction associated with the poorest retention in care was quite large, approaching that associated with having a baseline CD4 cell count <200 106 cells/L. Giordano et al. conclude that even in a system with few financial barriers, a great deal of HIV-infected patients continue to have poor retention in care. Poor retention in care predicts poorer survival with HIV infection, and therefore, patient retention should be examined further to improve survival.  


Case Study: Louisiana Public Health Information Exchange (LaPHIE)

Various models exist to address systemic challenges and improve patient retention. For example, the Louisiana State University (LSU) Health Care Services Division, which runs several public hospitals, and the Louisiana Office of Public Health (OPH) created a partnership called the Louisiana Public Health Information Exchange, or LaPHIE. The partnership was made possible through funding from HRSA's Special Projects of National Significance and sought to remove system-level barriers, improve organizational communication strategies, and enhance patient health outcomes. In short, LaPHIE established an electronic link between OPH clinics and LSU's electronic medical records system to link into care PLWHA who are not in care. OPH maintains the list of PLWHA in the state and also receives and tracks their CD4 and viral load test reports.


LaPHIE automatically generates a message that a certain patient is "out of care" if there is no CD4 or viral load test result reported for a year. If that patient then enters care at any of the LSU hospitals, a message shows up in the electronic records system. In addition, the doctor or nurse gets an instant message that the person tested HIV positive but is not currently receiving care, providing an opportunity to reengage that patient. In the program's first 14 months, 199 patients were identified as out of care, and of those, 89 have returned to care. LaPHIE highlights what's possible when grantees join forces and look for innovative ways to overcome systematic challenges and, subsequently, improve clinical outcomes. (To learn more about LaPHIE see Using HIV Surveillance Data to Prompt Clinical Action.)

Connect. With patients.
Collaborate. With a community of learners.
Change. The course of HIV. 

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