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in+care Newsletter | Issue 13 


National Campaign to Improve Retention in HIV Care
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In This Issue
Enhanced Reports Released
2013 Data Submission Deadlines
Provider Spotlight
Journal Spotlight

28 days

until the next data submission deadline

Enter your data at: incarecampaign.org/database

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Data - National Averages*

(as of 12/20/12)

Gap Measure
(n = 138 sites, 88,325 patients)


Visit Frequency Measure
(n = 125 sites, 73,254 patients)

New Patient Measure
(n = 132 sites, 6,524 patients)

Viral Load Suppression
(n = 133 sites, 98,996 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


New Resources Posted Online*
New Items
November Campaign Webinar
November Partners Webinar
New Additional Resources
New Groups of Items
Enhanced Reports Folder
AGM Materials Folder
Summit 2012 Folder



Happy New Year! One of the gifts we have received is the gift of life and hope afforded through combination antiretroviral therapy for HIV. We have seen fewer deaths caused by HIV. Part of aging, however, is the gradual onset of chronic, non-communicable diseases such as diabetes miletus, hypertension, and other conditions common in the general population. The complexity of care for aging HIV patients is making it all the more important to remain engaged in primary care. This newsletter issue is dedicated to issues surrounding HIV, aging and retention.

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, January 7 - Open Space, no scheduled topic

Wednesday, January 9 - Patient Experience Evaluation Techniques

Monday, January 14 - Open Space no, scheduled topic

Wednesday, January 16 - Hurdling Over Individual Barriers to Care

Monday, January 21 - Campaign Offices Closed, no Office Hours

Wednesday, January 23 - QI 101 for Retention Issues


Dial-in#: 866.394.2346

Participant Code: 418 257 6142 #


+ in+care Campaign Webinar | Sustainability of Retention Projects in Unsure Funding Environments

Wednesday, January 9, 2013 at 2pm ET

Agenda: Amy Sitapati of the Owen Clinic at UCSD will present on her agency's progress in sustaining retention projects once the dedicated funding source for them has expired. This is an issue of great importance, because as we know, eventually, almost all funding comes to an end, but our work never does. We will also be reviewing the data that has been submitted through the in+care Campaign to date and introducing our new enhanced data reports - Ryan White Parts by Measure! If you have any specific questions you'd like to have addressed through this program, please contact Michael at Michael@nationalqualitycenter.org. No pre-registration needed, just enter the room as a guest at the time of this program.

Dial-in#: 866.394.2346

Participant Code: 397 154 6368 #

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



+ in+care Campaign Webinar | Mental Health and Retention

Thursday, January 10, 2013 2pm ET

Agenda: Kevin Moore of AIDS Care Group in Chester, PA will present on the connection between mental health and retention. He will focus on miscommunication between medical and behavioral providers that leaves patients in vulnerable situations. He will also describe opportunities for building mental health into HIV Patient Centered Medical Homes. In addition, Mike Rollison of Virginia Commonwealth University will present his process diagram for linking mental health patients to HIV primary care developed through the SPNS Linkage to Care Project of Virginia as another example of successful quality improvement interventions.

Campaign staff will also be reviewing the data that have been submitted through the in+care Campaign to date and introducing our new enhanced data reports - measures by Ryan White Part! If you have any specific questions you'd like to have addressed through this program, please contact Michael at Michael@nationalqualitycenter.org
. No pre-registration needed, just enter the room as a guest at the time of this program.

Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #

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



+ Journal Club Webinar | How Can We Increase the Initiation if and Retention in Care for Persons Living with HIV?

Wednesday, January 30, 2013 at 2pm ET

Agenda: Dr. Medha Vyavaharkar of the University of South Carolina will present the findings from an on-going qualitative research study that is designed to gain a better understanding of factors that may facilitate or impede initiation and continuation of HIV care in a rural county with a predominantly minority population in South Carolina. In addition to the patient-specific themes such as desire for survival, self-determination, and fear of disclosure, themes related to organizational culture and characteristics emerged as critical elements in retaining patients in the care system. These findings will help individuals and organizations that offer services to PLWHA to reflect upon their interactions with clients and formulate strategies to improve the care retention rates

30 minutes will be saved for questions from the audience. If you have any specific questions you would like to have addressed, please mail them to Michael@nationalqualitycenter.org in advance! No pre-registration needed, just enter the room as a guest at the time of this program.

Dial-in#: 866.394.2346

Participant Code: 397 154 6368 #

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



+ Next Campaign Performance Data Submission

February 1, 2013


+ Next Improvement Update Form Submission

January 15, 2013

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


Enhanced Reports Released!

The in+care Campaign is pleased to announce the release of its much anticipated enhanced reports. The first version of these reports examines data submitted by participants in two ways: Ryan White (RW) Part by Measure (organized by Campaign measures) and Measure by RW Part (organized by RW Part). The data are represented in three views - a table, a run chart and a spark line distribution spread.

The data table shows how each RW Part performed for each of the four measures across the six most recent reporting periods. In addition to direct grantees of the four RW Parts included in the Campaign (A, B, C and D), the table includes a Total that rolls up the direct grantee data in addition to data submitted by sub-grantees. Data presented in the table include the community average performance, expressed as a percentage in addition to the number of sites reporting and the number of patients represented in the sample.



The run chart tracks performance over time for each of the RW Parts for each measure. Over time, additional observations will be added for each reporting period tracking the full history of Campaign participant performance. The chart is marked to the right with arrows indicating whether a higher or lower score is a good score (remember that the Gap Measure shows stronger performance in lower percentage scores whereas the Visit Frequency, New Patient, and Viral Suppression Measures show stronger performance in higher percentage scores).

 Run Chart Campaign

Spark lines were created by Edward Tufte as a novel way to display data distribution among reporting entities. Since quality improvement across at the clinic level and since aggregating clinic performance scores often leads to loss of information, the in+care Campaign has included this additional granular method in its analyses. Spark lines are a way to describe community performance without compromising patterns of performance among reporting sites. The beauty and utility of spark lines lies in their showing the spread of performance in the reporting period. In these displays, each little tick mark represents an individual reporting entity's score. The red mark is the median of the reported scores and the blue marks represent the 25th and 75th percentiles of the reported scores. Please note that the spark lines only report data on the reporting period containing the most recent complete dataset, as opposed to the data table and run chart that display performance across multiple reporting periods. The reporting period being displayed is always noted parenthetically above the spark line displays.


Spark Lines Campaign  

As with any data report, this one is not without its limitations. All data are aggregate data points self-reported by HIV provider sites participating in the in+care Campaign. Participants have opportunities to describe their individual limitations for each observation entered into the in+care Campaign database. Data collection methods vary by participating site and RW Part funded. Some site data could be counted multiple times if it was submitted individually by the participating site in addition to a networking lead agency and if the site is part of a network of providers (i.e., a Part A or Part B sub-grantee). Patient counts are not unduplicated. A patient may be counted more than once in the denominator if s/he received care at multiple sites. Data collection may be incomplete due to individual clinics' limitations. Finally, some participating sites submit data for a sample of patients.

Visit www.incarecampaign.org to see the reports (click RESOURCES and look in the Enhanced Campaign Reports folder toward the bottom of the list of folders). As always, please email Michael Hager with questions - Michael@NationalQualityCenter.org.

2013 Data Submission Deadlines

As we move into 2013, several Campaign participants have asked about the data submission deadlines for the coming year. Campaign staff has updated the website homepage in addition to the Campaign User Guides under Resources (FAQ, Data Submission Instructions, and Measures Descriptions). We also want to make sure you are aware of the schedule here in our newsletter.


2013 Campaign Data Submission   

Thanks so much to everyone who has participated in our data submission arm of this Campaign! If you are interested in working with data submission, but don't know where to start, please email your Campaign Quality Coach (see list on Campaign homepage) or Michael Hager at Michael@NationalQualityCenter.org.

Provider Spotlight - CARES Clinic of Sacramento, CA

Advancements in treatment of HIV have enhanced both the quality of life and the longevity for those affected. As providers now consider HIV to be a chronic disease, it has become increasingly important to develop and provide quality care for aging patients living with HIV. This has brought new concerns to the table, as aging patients face a myriad of other health concerns in addition to living with HIV. The resulting complexity of treatment looms as a pressing concern for providers while the HIV population ages. The Center for AIDS Research, Education & Services (CARES) in Sacramento CA has risen to address this challenge. Established in 1989 around the height of the HIV/AIDS epidemic, CARES has been on the frontline for a long time. It currently receives Ryan White Part A, B, C and D funding for its program. CARES serves 2,600 active HIV+ patients, 74% of which fall below 200% of the poverty level. Janet Parker and Emily Tsuchida of CARES Clinic provided evidence of the shifting demographics of their clients in recent years and stressed the importance of this development for HIV care.

An Aging Population at CARES



This chart clearly indicates the number of patients over 45 years old (shown in red) has steadily increased over time. In response to the demands of an aging HIV-infected population, Janet and Emily have set forth to expand the offerings of the CARES Clinic in a variety of specific ways. In a recent in+care Campaign webinar on HIV and Aging, Emily mentioned first the importance of actively assessing aging patients for exposure to risk factors and testing them. Emily then discussed the factors to consider for appropriate treatment of aging HIV patients, including: managing multiple medications; evolving nutritional needs; mobility, isolation, and access to care; loss of cognitive function; mental health; sexual activity; and paying for care after retirement. All of these concerns shape the experience of aging HIV-infected patients and are important to integrate into care.


In addition to coordinating these various components of care, CARES Clinic is taking an active role in retaining patients in care. Janet said they follow up on those that are inactive for 12 months, and send an employee into the field to check on people they cannot reach. They also have an early warning system in place, in which an employee is notified to follow up if a patient has not had a medical appointment in the last 6 months. On top of all this, CARES is dedicated to upholding a friendly atmosphere and connecting to the local community. Many of their employees speak Spanish and other common languages spoken in the Sacramento area. As more and more HIV providers must face the challenge of reaching out to aging populations, the work done at CARES Clinic provides a useful model for the future.

Journal Spotlight - A Low-Effort, Clinic-Wide Intervention Improves Attendance for HIV Primary Care

Gardner, L.I., Marks, G., Craw J.A., et al.  A low effort, clinic-wide intervention improves attendance for HIV primary care.  Clinical Infectious Diseases 2012; 55(8):1124-34.

In this article Gardner et al. examine ways to communicate retention expectations to clients and if this type of intervention improves retention.  The authors stress that working towards increased retention is essential from both the clinical and national perspective.  Specifically, retention directly correlates to the goals of the National HIV/AIDS Strategy and is in alignment with the in+care Campaign. 

The Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) jointly funded a 2-phase, 5 year project to implement strategies that promote retention in care.  This article discusses phase I - the evaluation of clinic-wide strategies to improve retention in HIV primary care at six clinical sites.

Phase I focused on communication strategies in the HIV clinic settings:

  • Print materials -
    • Brochures highlighted the significance of staying in care
    • Posters hung in waiting room and exam room displayed messages from research studies pointing to better health status for those in consistent medical care.
  • Tailored messages to the client -
    • Used by all staff in the clinic
    • Thanked the client for keeping appointment
    • Referenced positive research results for clients that stay in care
    • Emphasized client's role as part of the care team focused on keeping the client healthy

In order to determine effectiveness of communication interventions Gardner et al. evaluated the client's HIV primary care attendance one year prior to the improvement interventions compared to attendance for one year after the client had experienced the new communication interventions. Visits were examined for both short term (next 2 visits) and longer term (proportion of all scheduled visits kept) effects.  Results are as follows:

  • Short Term Results - 7% (P <.0001)  relative increase post intervention for keeping the next 2 visits
    • New or re-engaging clients' short-term retention improved by 28.2% vs. active (continuing) clients' short-term retention who improved by 5.3%
    • Short-term retention for clients with detectable viral load improved by 16% vs. short-term retention for clients with undetectable viral loads, which improved by 5.6%
    • Younger clients (16-29 years old) also demonstrated significantly more improvement
  • Longer Term Results - 3% (P <.0001) relative increase post intervention for the proportion of kept visits.
    • High rates of retention were again seen for new or re-engaging clients, clients with detectable viral loads, and young (age 16-29 years old) clients
    • As number of scheduled client visits increased over time, the percentage of clients that kept all visits decreased

The implementation process was also assessed every 3 months. The assessment involved surveying 50 random clients seen during one week to determine if they received the brochure and if the healthcare provider discussed the importance of staying in care and keeping medical appointments. Of those surveyed between January 2010 and April 2010, 87.6% of clients reported their provider talked to them about keeping all medical visits and 57.5% received a brochure. 

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

incareCampaign.org  |  212-417-4730