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in+care Newsletter  |   Jan 2012  


National Campaign to Improve Retention in HIV Care
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In This Issue
Monthly Update
Upcoming Events
Journal Spotlight
Dating Your Data
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Campaign Updates
Number of providers who submitted Campaign indicator performance data in Dec 2011:
Number of patients who were entered in the Campaign database in Dec 2011:
Number of providers and sub-providers that have joined the campaign:


Number of HIV patients served by participating providers (not unduplicated):


8 days

until the next data submission deadline

Enter your data at: incarecampaign.org/database

Quick Links


Campaign Headquarters

National Quality Center (NQC)

New York State Department of Health AIDS Institute


90 Church Street, 13th floor
New York, NY 10007


Work: 212-417-4730
Fax: 212-417-4684


Monthly Update

Welcome to the January 2012 in+care Newsletter. The first data submission deadline is almost two months behind us, and it is important for us to utilize the data reported for the Campaign to initiate improvements.


This is a good time to closely review the data and determine which process improvements you can implement to have an impact on your performance.  Remember, the next data submission is Wednesday, February 1st. To do this, it may help to take the time to learn more about the people who are not retained in care per your measurement reports. What can you do to address the barriers to retaining those patients in care? Have you had any conversations as a provider community about these patients?


You can call into our Campaign Office Hours anytime between 4 and 5pm ET on Mondays and Wednesdays with any specific questions you may have or to find assistance in improving your retention rate. Also, don't be afraid to reach out to your Campaign Coach with any questions.

Upcoming Events  

+ in+care Campaign Office Hours

Every Monday and Wednesday 4-5pm ET

We are happy to introduce regularly scheduled Office Hours for in+care Campaign participants to directly communicate with NQC staff and consultants. Callers can ask general questions, request technical assistance, or engage in dialogue about the Campaign.

Office Hours will be held from 4-5pm ET on:

  • Wednesday, January 25th
  • Monday, January 30th

Dial-in#: 866.394.2346
Participant Code: 4182576142#


+ March in+care Webinar

Wednesday, March 14, 2012 at 3pm ET

This webinar will focus on issues related to incarceration and will be facilitated by Dr. Brian Montague.


Keep up-to-date with the latest in+care events through our webpage: http://incarecampaign.org/index.cfm/75283

Journal Spotlight: Giordano, TP. "Retention in HIV Care: What the Clinician Needs to Know"

Giordano, TP. Retention in HIV Care: What the Clinician Needs to Know [conference presentation]. Ryan White 13th Annual Clinical Conference; August 2010; Washington, DC.


Practical steps can be taken by practitioners and clinics to improve poor retention in HIV care. This is the message Dr. Thomas P. Giordano expressed in his lecture to fellow HIV clinicians at the 13th Annual Clinical Conference for Ryan White HIV/AIDS Program held in Washington, DC in August 2010. Retention ultimately affects the patient's and population's health, as well as the efficiency and productivity of HIV clinics.   Dr. Giordano described the negative patient health outcomes associated with poor retention in care including: 1) decreased likelihood of receiving ART; 2) higher rates of ART failure; 3) increased HIV transmission risk behavior; 4) increased hospitalization rates; and 5) worse survival. Dr. Giordano also highlighted several studies that demonstrate increased retention when patients are actively involved in their own care process from the beginning. The HRSA Special Projects of National Significance (SPNS) Outreach Initiative studies, for example, showed baseline engagement in care can predict subsequent retention in care. Furthermore, those patients that worked with providers to remove structural barriers that prevent them from fully engaging in care were better retained at 12-month follow-up.


Dr. Giordano identified several challenges within retention - measurement issues; patient-, provider-, and system-level issues; and staffing and resource issues. Client-level challenges may include retention-adherence behavior and drug/alcohol dependence, while challenges at the practitioner and systems level include poor provider communication, scheduling systems and clinic access. Finally, issues exist with insufficient support for clinics in both medical and support services. Many experience problems when Ryan White HIV/AIDS program grantees remain flat funded but the newly-diagnosed client population increases each year. Giordano encouraged HIV clinicians to address the challenges that best suit the needs of the clinic.


Giordano suggested 10 immediate measures that clinicians can implement to improve retention:

  1. Track no-show rates and rates of patients who leave care.
  2. Examine your agency's processes of retaining patients in care with the understanding that bringing patients back into care once they are out is difficult.
  3. Work with personnel from community agencies (EDs, jails, public health departments, etc.) to identify patients poorly retained in care and strengthen relinkage processes.
  4. Build and strengthen outreach or peer-navigator programs.
  5. Work with existing resources, highlight the importance of retention to staff and have staff members advocate with patients for retention.
  6. Improve the patient's experience; good "customer service" likely leads to return visits.
  7. Minimize unmet psychosocial needs by strengthening receipt of substance-use, mental health, case management, and social services.
  8. Minimize the time between scheduling appointments and the date of appointments.
  9. Do a pilot trial of wider appointment availability and consider open appointment access if suitable.
  10. Remember that patients generally know they should be in care. Help patients by: a) providing reminders, b) encouraging patients, c) working collaboratively with patients to solve problems, just as you would to improve medication adherence.

To view the recording of the January Meet the Author event about this lecture click here.

Dating your Data

It's time to abandon the coy looks; no more beating around the bush about how you feel. You are in a position where you need to enter a commitment with your program data. And while the outcome will likely be positive, some fear about what will be expected; this is perfectly natural.

 dating your data

There are a few ways you can treat your program data so you can start to build a lasting bond.


Step 1. Clearly communicate what you want and need from the data. Imagine you are creating an online profile for yourself where you get to describe what you want and need from this relationship. Use strengths-based, positive language when describing data expectations from the beginning. Infuse data expectations in contracts and other official documents. At the same time, be willing to meet providers and staff where they are in terms of understanding the program data. Become a partner in helping programs reach their full potential. Remember, this is the beginning of the relationship; don't scare off your data providers by asking too much too soon.


Step 2. Get to know your data really well. By joining the in+care Campaign, you've already agreed that you're going to focus on the four performance measures related to retention so your conversations will be centered on how you get clients into care and what keeps them engaged in care. Talk to each person involved in working with your consumers including the consumer themselves. How did they choose this agency? How did they get their first appointment? What made it easier for them to get to you? Why did they come back? Discuss how the role each staff member plays can impact whether or not your clients return as frequently as you'd like.  


Step 3. 'Date' your data! Even if you spend all day every day entering data into a database or reviewing charts or data forms, it is really important to take the time to learn what your entire dataset says about your program. Schedule meetings on a regular basis that are data-centered. Include a diverse group of people that interact with consumers to add to the discussion about what the numbers mean, what they don't mean, and how to make necessary improvements in the system that will change those numbers in the desired direction. Identify successes and barriers to retention during these meetings as reflected by the data. Build your action plans with this information. The action plans that you develop are more likely to consider measurement as part of the conversation; not an afterthought. Also, by including data entry staff, clinical staff, and consumers you are communicating the importance of making data a part of your practice.      


Step 4. Be sensitive to the ongoing needs of your data. Review your data more often when you have staff changes; new staff will need more assistance understanding your software platform and the process of how a visit becomes one or more data points. Plan how the data entry will occur around vacation and sick time. Identify data champions and have them help you provide technical assistance to staff that need a little more face to face assistance. Be willing to meet the need.


Step 5. Take steps to keep the momentum alive. It happens in a lot of good relationships. Eventually we all get distracted by the rest of life, increasing the potential for disconnect between what we think we are doing and what we are actually doing. Train your data entry staff on an annual basis. You'd be surprised how many people play the 'telephone' game with data entry processes. So-and-so said we can estimate birthdays; so-and-so said I don't have to enter that! You can lose months worth of information if you aren't careful- or worse, find yourself needing to enter piles and piles of data that would've otherwise required maybe 15 extra minutes a day.


Step 6. Don't be afraid to display your data publically. You must have commitment for the process if you are going to have any successes in using data to measurably improve program outcomes. Be willing to share your information with other providers. It's really powerful to know how your data compares at each different level- between agencies, geographies, and/or client populations. Action plans that work for one group might not be appropriate for another. And who doesn't enjoy seeing a little public display of data affection?       


By following these steps in any order, a positive, healthy, lasting relationship can be built between you and your program data. Remember, data aren't separate from care delivery but an integral part of it.

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

incareCampaign.org  |  212-417-4730