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(as of 2/22/12)
February Average for Measure 1: Gap Measure
(n = 139 sites, 90,411 patients)
February Average for Measure 2: Visit Frequency Measure
(n = 80 sites, 50,789 patients)
February Average for Measure 3: New Patient Measure
(n = 135 sites, 7,912 patients)
February Average for Measure 4: Viral Load Suppression
(n = 135 sites, 106,216 patients)
until the next data submission deadline
Enter your data at: incarecampaign.org/database
National Quality Center (NQC)
New York State Department of Health AIDS Institute
90 Church Street, 13th floor
New York, NY 10007
Welcome to the February newsletter for the in+care Campaign! We continue to collect data on the first two reporting cycles and our patient pool now contains nearly 110,000 patients for Measure 4 (not unduplicated); 143 participating sites submitted data for February so far, which shows how committed Ryan White providers are to this Campaign nationally.
All Campaign participants have been assigned a Quality Coach to assist in day-to-day questions related to in+care performance measurement data submissions and the development of improvement projects. You should have been contacted by your coach and received feedback on your data submission and improvement update. In the event that you have not been contacted, please contact the NQC at incare@NationalQualityCenter.org. In addition to the coaches, Campaign staff are also available to provide assistance, as we try our best to sort out the many types of organizations participating in this Campaign and how each of you can best be involved.
In this newsletter you'll find a summary of data submission deadlines and corresponding measurement periods, a reminder of upcoming events, a journal spotlight on a recent article by Tripathi et al. entitled, "The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study," and a spotlight on the Rhode Island Regional Group. Please don't hesitate to contact us with any comments or questions at incare@NationalQualityCenter.org.
National Quality Center
|Data Submission Deadlines|
|t action, if any, do you want your members to take? Add a "Find out more" link to additional information ou may have hosted on your website. |
+ 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, February 29th - Partners in+care Engagement
- Monday, March 5 - Open Space
- Wednessday, March 7 - Enhancing Communication between Medical and Support Agencies
- Monday, March 12 - Open Space
Participant Code: 4182576142#
+ March in+care Webinar
Wednesday, March 14, 2012 at 3pm ET
This webinar will focus on incarceration and patient retention in HIV primary care and will feature Dr. Brian Montague of the Miriam Hospital in Providence, RI. Dr. Montague is an expert on peri-incarceration and patient retention and will present provider success stories in this area. A campaign participant will also present their lessons learned, and improvement updates will be shared.
Participant Code: 3971546368#
+ Dr. Michael Mugavero Journal Club
Thursday, March 15, 2012 at 12pm ET
This webinar will feature Dr. Michael Mugavero, a prominent researcher with an extensive track record of publishing in the field of retention and HIV. Dr. Mugavero from the University of Alabama 1917 Clinic presents the results of his most recent research and will answer questions from participants. Join us.
Particpant Code: 3971546368#
Keep up-to-date with the latest in+care events through our webpage: http://incarecampaign.org/index.cfm/75283
|Journal Spotlight: Tripathi, A et al. "The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study."|
Tripathi A, Youmans E, Gibson JJ, Duffus WA. "The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study." AIDS Research and Human Retroviruses. 2011 Jul;27(7):751-8.
This retrospective statewide study of residents diagnosed with HIV in the South Carolina surveillance database was conducted:
- to determine retention rates after initial linkage to care was established,
- to characterize factors associated with lower retention after initial entry into HIV care, and
- to examine the association of retention in the first 2 years with clinical outcomes and survival.
The utilization of statewide data in this study allowed Tripathi et al. to account for patients who continually/simultaneously access care from different providers.
In this cohort, Tripathi et al. found that approximately 50% of patients failed to maintain optimal retention in medical care after initial linkage as defined by a 6-month medical visit measure, even after taking into account those who access different providers in the state for reasons related to relocation, incarceration, convenience, or insurance changes. Male gender, nonwhite race/ethnicity, younger age, delayed linkage, and HIV-only status were significant predictors of sporadic retention or "dropout" as compared to optimal retention.
Optimal retention in this analysis was defined as a medical visit in each of the four 6-month intervals after initial linkage to medical care, while suboptimal required visits in three intervals, sporadic in two or one interval, and dropout included no medical visits over the 2 year period.
Through statistical analysis, Tripathi et al. found that the average decrease in viral load and the average increase in CD4 count were greatest among those with optimal retention compared to suboptimal and sporadic retention. Results from the analysis also suggest that the mean decrease in viral load and mean increase in CD4 count was greater among whites as compared to other racial and ethnic groups, and in those concurrently diagnosed with HIV and AIDS as compared to a diagnosis of HIV only.
Finally, after controlling for other variables, the analysis found an increased risk of mortality based on the following characteristics: sporadic retention and "dropout" as compared to optimal retention, older age at time of HIV diagnosis, and a concurrent diagnosis of HIV and AIDS. Those who dropped out of care were four times as likely to die of HIV/AIDS-related illness as compared to those maintaining optimal care.
This study fills an important gap in retention literature by taking a statewide view of retention, thus Tripathi et al.'s research provides strong support for sociodemographic factors and clinical stage at diagnosis as important predictors of retention in care. Further, their research indicates that improvement in viral load, CD4 count, and survival outcomes can occur if retention is increased in the initial 2 years of HIV care.
|Rhode Island Regional Group|
A regional group was established in Rhode Island for participation in the in+care Campaign. This group includes Ryan White HIV/AIDS Program Parts B and C-funded clinical providers as well as AIDS service organizations (ASOs) funded through Parts B and D. Prior to the establishment of the Campaign, communication between medical providers and case managers within the ASOs was a recognized challenge.
Facilitated by Dr. Montague at the Miriam Hospital and with the support of the Ryan White Part B Quality Program within the state health department, the group established a model for regional collaboration for the Campaign that will include the following action steps.
- Establish communication channels between the ASOs and the medical providers. This will ensure medical providers are aware of which patients are accessing case management and what support services they are receiving.
- Generate in+care performance measures at the medical provider sites. These will include aggregate measures, ASO specific measures, and measures for those not engaged in case management.
- Systematic communication between the ASOs and medical providers on patient issues in regards to visits, lab monitoring, and other key measures required for Ryan White HIV/AIDS Program reporting.
- Hold regional group follow-up meetings to review performance measure data and plan collaborative quality interventions.
This strategy reduces the work burden for ASOs requesting patient follow-up status and creates capacity for these organizations to focus on interventions for those at risk for falling out of care. It also allows for more efficient communication between medical providers and case managers as part of ongoing care.
A key challenge, however, will be developing ways to systematically track and communicate patient and service rosters at the ASOs, many of whom are only beginning to track these electronically. The State migration to CAREWare for all Part B-funded providers may be an important facilitator for this moving forward.
A successful collaboration will be one that minimizes reporting redundancies between participating agencies and thus allows participants to more readily focus on retention enhancing initiatives. Leveraging communication through this collaboration to make other required reporting processes more efficient can enhance buy-in from participating agencies.
The partnership between medical providers and ASOs is also essential as many interventions that have potential to enhance retention require cooperative action between these groups, and benefit from the sort of outreach only possible through ASOs.