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in+care Newsletter

Issue 15 


National Campaign to Improve Retention in HIV Care
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In This Issue
Partners in+care Planning
Integration of Retention Efforts
Provider Spotlight
Featured Article

24 days

until the next data submission deadline

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Data - National Averages*

(as of 02/28/13)

Gap Measure
(n = 137 sites, 92,518 patients)


Visit Frequency Measure
(n = 127 sites, 73,518 patients)



New Patient Measure
(n = 134 sites, 6,320 patients)



Viral Load Suppression
(n = 131 sites, 101,144 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


Website Updated!

 The in+care Campaign has recently updated its website to make searching for Retention Strategies and Tools easier for you! Visit the website today to explore the new area!

Social Service Providers and Retention


We oftentimes think of clinical providers when discussing retention in care. The truth is, however, that all providers with whom people living with HIV come in contact can make a mark on retaining patients in ongoing care. This is especially true of social service providers who have historically formed close bonds with their clients, such as case managers, peer advocates, or patient navigators. Additionally, there are many opportunities for nutritional, housing services, and even transportation providers to have an impact on patient retention - often by as little as a simple routine conversation, frequent reminders to stay in care, or through posters and distribution of literature. The month of February was dedicated to all the ways in which non-medical providers can move the needle on keeping more patients in HIV care.
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, March 11 - Open Space, no scheduled topic

Wednesday, March 13 - Tackling HIV Stigma

Monday, March 18 - Open Space, no scheduled topic

Wednesday, March 20 - Patient Waiting Time and QI Opportunities

Monday, March 25 - Open Space, no scheduled topic

Wednesday, March 27 - Front Line Staff and Patient Experience

Monday, April 1 - Open Space, no scheduled topic


Dial-in#: 866.394.2346

Participant Code: 418 257 6142 #



+ Combined Journal Club and Partners in+care Webinar | Patient-Centered Outcomes Research Institute (PCORI)
Thursday, March 28 at 2pm ET
Agenda: PCORI helps people make informed health care decisions and improves health care delivery and outcomes by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community. PCORI staff will present some of their recent work and a panel of Partners in+care will respond based on their own experiences.
If you have any specific questions you would like to have addressed, please mail them in advance of the webinar to Michael@NationalQualityCenter.org. No pre-registration is needed, just enter the room as a guest at the time of this webinar.
Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #



+ Partners in+care Webinar | Substance Use, HIV, Linkage and Retention in+care

TO BE DETERMINED - Date and time coming soon!

Agenda: It takes more than medical services to keep people living with HIV engaged in medical care. David Thompson from the Substance Abuse, Mental Health Services Administration (SAMHSA) of the Federal Government will share information on a linkage to care project that SAMHSA has in place. Provider agencies involved in this program will be present on the line to discuss their thoughts on how well it ensures patient linkage to care. In addition, Campaign staff will review recent improvement updates from around the nation that pertain to social services. Lastly, there will be a discussion of recent in+care Campaign data submissions.


If you have any specific questions you would like to have addressed in advance of the webinar, please mail them to Michael@NationalQualityCenter.org. No pre-registration needed, just enter the room as a guest at the time of this webinar.


Dial-in#: 866.394.2346

Participant Code: 397 154 6368 #

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



+ in+care Campaign Webinar | Patient Experience Evaluation and Retention
TO BE DETERMINED - Date and time coming soon!
Agenda: If you were to ask patients how they know they are receiving high quality health care, the funniest thing happens - they will begin talking about their experiences in terms of relationships, interactions and the status of the physical plant. After all, they did not receive the years of training that clinical providers received and have no real basis for evaluating the clinical quality of their care. For this reason, patient experience is a major driver to patient retention in care. This webinar will focus on ways that patient experience can be evaluated and measured so that provider agencies can respond in kind. In addition, Campaign staff will review recent data submissions and other strategies being implemented within the provider community participating in the in+care Campaign.
If you have any specific questions you would like to have addressed, please mail them in advance of the webinar to Michael@NationalQualityCenter.org. No pre-registration is needed, just enter the room as a guest at the time of this webinar.
Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #
+ Next Campaign Performance Data Submission

April 1, 2013



+ Next Improvement Update Form Submission
March 15, 2013
Keep up-to-date with the latest in+care events through our webpage: http://incarecampaign.org/index.cfm/75283


Looking for Members: Partners in+care Planning

The Partners in+care Planning Committee is seeking new members to help design innovative and value-added programming for the in+care Campaign. Campaign staff is specifically looking for people with HIV and those that support them to engage in conversations around quality improvement and retention in care. Some experience in discussing and working on quality improvement matters is preferred, but anyone seeking to make a difference is welcome.


Meetings of Partners in+care participants are held on the third Monday of each month at 1pm ET. Topics of conversation revolve around Facebook postings, webinar development, and Partners in+care Toolkit development. If you are interested in joining the Partners in+care Planning Group, email Michael Hager at Michael@NationalQualityCenter.org. Get involved today and leave your mark on this important national endeavor!

Ideas You Can Try in the Field- Horizontal and Vertical Integration of Retention Efforts

Fifteen months into the in+care Campaign, one of the most important structural interventions to improve patient retention in HIV care is communication and integration of efforts within communities. This not only includes horizontal integration (discussion of retention issues across provider agencies at Planning Council, Community Fora, etc), but also includes vertical integration (inclusion of grantee lead agencies and ultimate funders in the dialogue). Integration of efforts on these levels is important  since no one agency works in a vacuum. In fact, many agencies within a community may be in contact with a single patient or groups of patients.


What efforts have been made in your community to bring provider agencies of all types together to discuss the issue of patient retention in HIV care? Have you included your network lead agencies and your funders in these conversations? There are many ways that these types of meetings can be convened and there is no right answer in terms of how to get the ball rolling for these meetings. Your Campaign Quality Coaches are excellent resources available to help you think through these types of meetings - whom to invite, what the agenda should have on it, is a face-to-face or virtual meeting better? Michael Hager is also available to help you think through these questions. Email him at Michael@NationalQualityCenter.org.

Provider Spotlights-  Involving Social Service Providers in Retention Efforts

While the term "retention in care" may seem to imply that retention is primarily the responsibility of clinical staff, Ryan White grantees are increasingly involving social service providers in their efforts to support patient retention.


Health Educators

The Gurabo Community Health Center in Gurabo, PR uses health educators to identify patients who have missed medical appointments or have not completed their laboratory follow up. Once patients are identified, they are contacted and referred to a clinical case manager. A major barrier to accessing care remains transportation. To address this barrier, outreach staff provides transportation, when necessary. Another challenge faced by the health center related to the rescheduling of missed appointments due to a temporary lack of a medical clerk. The scheduling issues were resolved once these administrative services were reinstated.


Peer Mentors

Peer mentors help to support HIV-infected women who receive services from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School AIDS Program (RWJAP) in Piscataway, New Jersey. The peer mentors contact patients and discuss strategies to help the patients remain in or return to care. The mentor focuses on the reasons behind missed appointments, missed refills, and the need for other ancillary care (e.g., Pap smear). Some of the challenges facing the patients include job loss, insurance lapse, inability to complete paperwork for entitlements, treatment fatigue, substance abuse, mental illness, and issues within personal relationships. Having experienced many of these challenges, the peer mentor can serve to engage the patient and share their own experiences about overcoming similar challenges.


Medical Case Managers

In the Broward County Part A EMA, medical case managers were tasked with reviewing their case loads to ensure that those patients who appear inactive are contacted to determine whether they need assistance getting back into care or if they should be discharged from medical case management. In addition, the EMA addressed several documentation and data entry issues to ensure that the data accurately reflect patient retention rates. After resolving the data issues and reviewing caseloads, the EMA is exploring ways to take a proactive approach to prevent clients from falling out of care.


Journal Spotlight - Understanding the Behavioral Determinants of Retention in HIV Care

Smith, L.R., Fisher, J.D., Cunningham, C.O., et al. Understanding the behavioral determinants of retention in HIV care: a qualitative evaluation of a situated information, motivation, behavioral skills model of care initiation and maintenance. AIDS Patient Care 2012; 26(6): 344-355


In this article Smith et al. examine the use of a situated Information, Motivation, Behavioral Skills (sIMB) model to support retention in HIV care. There is a growing body of research focused on identifying individual-level factors associated with retention that may be influenced by behavior change efforts. The Information, Motivation, Behavioral Skills (IMB) model provides a multi-dimensional approach to address the cognitive, affective, and psychomotor domains of learning to promote behavior change. The IMB model has been used to support behavior change related to various chronic conditions. Research related to the IMB model indicates that levels of information, motivation, and behavioral skills have been shown to predict health behavior change. The sIMB model looks at contextual factors that may shape the kinds of information, motivation, and behavioral skills most relevant to behavior change. Both affective (i.e., emotional) and socio-cultural-environmental contexts are incorporated into the core constructs of the sIMB model.

The researchers used a mixed-methods qualitative analysis to identify the content and context of significant theory-based determinants related to retention in HIV care and to evaluate the applicability of the sIMB model. Qualitative data were collected via in-depth, semi-structured interviews with a sample of patients accessing traditional and nontraditional HIV care services in the Bronx, NY. Patients in the sample experienced many of the comordidities associated with HIV (e.g., substance abuse disorders, mental illness, hepatitis C).

Through analysis of interviews with study participants, sIMB model-based content was identified in all but 7.1 percent of the statements discussing facilitators or barriers to retention in HIV care. Factors influencing retention in care that were identified by participants included:

        * Acceptance of diagnosis;
        * Stigma;
        * HIV cognitive/physical impairments; and
        * Global constructs of self-care.


The results indicate that participants' experiences are reflective of the content and structure of the sIMB model and provide a systematic classification of important theoretical and contextual determinants of retention in HIV care. The researchers suggest that the model's determinants--information, motivation, behavioral skills-could play an important role in interventions designed to support retention. This work is useful in that it moves known correlates of retention in HIV care into a full-fledged and functional model.

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

incareCampaign.org  |  212-417-4730