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in+care Newsletter | September 2012

Issue 11 


National Campaign to Improve Retention in HIV Care
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In This Issue
Upcoming Events
MedScape News Today
Provider Spotlight
Journal Spotlight

57 days

until the next data submission deadline

Enter your data at: incarecampaign.org/database

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 Spread the word to help others make an impact on the lives of people living with HIV/AIDS.


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Data - National Averages*

(as of 9/24/12)


Gap Measure
(n = 161 sites, 105,944patients)

Visit Frequency Measure
(n = 149 sites, 87,809 patients)

New Patient Measure
(n = 158 sites, 6,624 patients)

Viral Load Suppression
(n = 158 sites, 124,254 patients)

*data not unduplicated
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


Working With You 


Happy Autumn! As an update to last month's  newsletter, the National Quality Center is pleased to announce that the in+care Campaign has been extended through the end of 2013. For those of you who have already gone in to enter October 2012 retention data, you have probably noticed that we have expanded the data selections listed under "period" to include February, April, June, August, October and December of 2013.
In addition to tracking data and improvement strategies for an additional year, we will continue to offer our full range of webinar programs for care teams and consumers across the U.S. Campaign quality coaching will continue in response to all your data and improvement strategy submissions. Of course, Local Retention Group activities and the Partners in+care community will also continue!
We are excited to continue working with you on this important initiative! If you have any questions, comments or concerns, please don't hesitate to email them to Michael@nationalqualitycenter.org!

Upcoming Events 

+ in+care Campaign Office Hours

Mondays and Wednesdays 4pm-5pm ET

Office Hours allow 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. Upcoming discussion topics include:

  • Monday, October 8 - National Holiday, no office hours
  • Wednesday, October 10 - Patient Health Questionnaire (PHQ) and You: Measuring Mental Health Outcomes
  • Monday, October 15 - open format; no scheduled topic
  • Wednesday, October 17 - Patient Navigation Systems
  • Monday, October 22 - open format; no scheduled topic 
  • Wednesday, October 24 - Patient Experience Evaluation 
  • Monday, October 29 - open format; no scheduled topic
  • Wednesday, October 31 - open format; no scheduled topic

Dial-in#: 866.394.2346

Participant Code: 418 257 6142 #



+ Clinical Aspects of Buprenorphine Therapy

Tuesday, October 9 2pm-3pm ET

Note: this is not an in+care Campaign event, but covers a topic related to retention in care

Agenda: Presenters will explain what buprenorphine is, how it works, what opioids do to the brain, how buprenorphine differs from methadone, important drug-drug interactions, the concept of precipitated withdrawal and how to recognize it, how to determine patient eligibility, and clinical aspects of this work.

Dial-in #: 888.889.5721

Participant Code: 990 1308 #



+ October in+care Campaign Webinar Events

Stay tuned for email announcements and website updates regarding our October in+care Campaign webinar programs! The topic of the month will be Mental Health so we are putting together webinar programs that focus on Mental Health and retention the general Campaign webinar and HIV Stigma and retention for Partners in+care.



+ Next Campaign Performance Data Submission
December 1, 2012



+ Next Improvement Update Form Submission
October 15, 2012



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

Opportunities for Consumers and non-Clinical Providers

Partners in+care is the part of the in+care Campaign that is engaging People living with HIV and those who care about them in this important national dialogue. Specifically, Partners in+care has two goals:

  1. What do I do to stay in care?
  2. How do I help my friends, family and clients stay in care?

Partners in+care has custom created consumer-driven webinars focusing on the consumer perspective on issues related to retention in care. There is also a private Facebook community where consumers and those care for them can come together to discuss issues critical to staying in care.


Learn more about Partners in+care by clicking on this link! The Partners page includes a toolkit containing useful educational materials and other resources we can use to discuss the importance of staying in care with people with HIV. If you are a direct service provider and have consumer champions who want to be involved, ask them to email Michael@nationalqualitycenter.org for details! All are welcome!

Provider Spotlight - Whitman Walker Health

Whitman-Walker Health is a non-profit community health center in the Washington, D.C. metropolitan area with a special expertise in HIV health care and Lesbian, Gay, Bisexual, and Transgender health care. Founded as an affirming health center for the gay and lesbian community in 1978, Whitman-Walker was one of the first responders to the HIVepidemic in Washington, D.C. and became a leader in HIVeducation, prevention, diagnosis and treatment. In recent years, Whitman-Walker has expanded its services to include primary health care services for the entire community regardless of HIV status, sexual orientation or gender identity. Whitman-Walker Health provides a number of health care services to the D.C. metro area through its two locations, including primary medical care, HIVprimary care, dental care, mental health services, legal help, medical adherence services and a pharmacy. Whitman-Walker Health annually produces AIDS Walk Washington, which is held in October and is the largest community-based fundraising event for HIVservices in Washington, D.C.




Performance measurement is the backbone of the Whitman-Walker Quality Improvement program. Over the course of each year, the Medical and Operations teams follow 47 performance measures that assess a range of processes and outcomes. Nearly every department at the health center is assessed through at least one performance measure. On the other side of the performance measurement coin, Whitman-Walker has a qualitative evaluation program. Patient feedback boxes are present in waiting rooms at both sites. Discreet services, like HIV testing, STD testing and support groups have continuous satisfaction surveys in place to assess client perception of services. Services requiring enrollment, such as medical, dental and legal care are assessed for client perception using annual client satisfaction surveys. Client satisfaction is assessed using one of these two models in each department. In the near future, QI staff is interested in pursuing enhanced patient experience evaluation methodologies such as periodic focus groups for all patients and routine discovery interviews for new patients. Results of all performance measures, both indicators and patient experience, are shared with consumer, staff and board level quality committees for their input and interpretation.


Four of the performance measures focus directly on identifying patients who are at risk of falling out of care. In addition, patient experience data from surveys and the feedback boxes are compiled and reviewed for issues that could affect patient retention in care. Over time, several strategies have been implemented to improve patient retention based on the results of these assessments.

  1. Patient Reminder Calls (before appointments)
  2. Follow-up Calls (for missed appointments)
  3. Walk-in Appointments for Patients at Risk of Missing Appointments
  4. Lists of patients to call who have not been seen in a certain period of time (prioritized by most recent recorded viral load and CD4 results)

Each of these strategies has positively affected patient retention in care; however, some strategies have been more successful than others. For example, allowing patients who routinely miss their appointments to walk-in for care has reduced the amount of waste in provider schedules and has also removed barriers to these patients from coming in when they are able to do so. Allowing patients who likely to no-show for appointments to walk in, significantly decreased the number of missed appointments from 26% to 22%. On the other hand, patient reminder calls have proven to be less efficacious than staff had initially hoped. Reminder calls led to no statistically significant improvement in performance for missed visits, though there was a decrease in negative patient feedback around the level of communication with patients based on this change. Whitman-Walker is proud of its track record in caring for its patients and responding to community needs. They will continue to strive to keep their patients healthy and in care for years to come!

Journal Spotlight -  International Association of Physicians in AIDS Care Guidelines

Melanie A Thompson, MD; Michael Mugavero, MD, MHSc; Victoria Cargill, MD, MSCE; Robert Gross, MD, MSCE; et al. Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care Panel. Annals of Internal Medicine. 2012;156: 817-833. 


A panel of the International Association of Physicians in AIDS Care (IAPAC) conducted a systematic review of 325 randomized, controlled trials and observational studies with comparators that had at least one measured biological or behavioral end point. Panel members drafted recommendations based on this body of evidence and assigned grades to each intervention method based on overall quality of the evidence and the strength of the recommendation on each intervention method. Quality of the body of the evidence is rated on a four point scale (I to IV), depending on the type of study conducted, the strength of the findings, and the number of limitations related to the results. Strength of the recommendation is graded on a three point scale (A, B, C) depending on the size of the patient group that would potentially benefit from implementation of the intervention method.


The recommendations in these guidelines are for monitoring entry into and retention in care, interventions to improve entry and retention, monitoring of and interventions to improve ART adherence, Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.


You can find a free copy of the IAPAC Guidelines for Improving Entry Into and Retention in Care at this link. In addition, you can find the slides from the September Meet the Author Journal Club that focused on these guidelines at this link.

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

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