> NQC News | in+care Campaign Update

As our participants know, the in+care Campaign is focused on retaining people with HIV in health care. In particular, patients new to care are vulnerable and need special attention to ensure that they are retained in care. This will be the Campaign's population of focus for the month of October. Research has shown that people who are not linked to and retained in care within the first year of their diagnoses are far less likely to engage in health care in time to avoid unnecessary adverse consequences. The in+care Campaign has collected a number of strategies from participating sites regarding this population, which will be shared in upcoming webinars.

What's Next?

The Campaign's active phase will be transitioning to a sustaining phase as of January 1, 2014. This means that the Campaign's newsletters and webinars will slow down, but you'll still be able to submit your retention performance data online to the in+care Campaign database for the foreseeable future.

In addition, news and important content related to the in+care Campaign will be shared and disseminated through the NQC e-Newsletter and the ongoing monthly NQC TA calls. Much of the content shared starting in January 2014 will focus on results and feature community providers that have kept Campaign staff up to date on the retention improvement strategies they have put in place at their agencies.

Learn more about the in+care Campaign | click here

After putting in 13 years as a volunteer at the Los Angeles Family AIDS Network, Patsy Lawson was a seasoned veteran. She was active on the community advisory board, participated in evaluation activities, took part in educational forums, and helped to organized clothing drives and other support activities. Then, she was named to the Los Angeles County Commission on HIV in July, where she will serve on the Standards and Best Practices Committee. This took her involvement to a whole new level.

Just months before she was named to the Commission, Patsy participated in NQC's Training of Consumers for Quality. The training is designed to increase the number of consumers actively participating in local quality management committees and regional quality improvement activities.

"Everything I learned at the training will help me," says Patsy. "Especially how to collect and analyze data and how to look at problems using PDSA cycles."

In addition to learning how to use quality improvement tools, the training provided participants with the expertise to determine when to use specific tools.

"We learned to look at the data and the preliminary results when doing PDSA cycles," says Patsy. "If your findings are inconclusive, it is better to move on to other issues that may be more important in terms of improving care."

Not only did the training provide concrete tools to participants, it also stressed the development of skills they will need to be effective advocates.

"It was reassuring. It gave me an opportunity to get used to people looking at me while I was speaking," says Patsy. "I left thinking that this is something I can do."

While she will bring her expertise and experience to the Commission, Patsy is also determined to bring another message.

"I want to provide insight into the African American community," she says. "We have often been a silent voice in this fight. We need to take leadership roles and stand up and be counted."

Patsy wasn't the only new member named to the Commission in July. Her daughter has also been named a Commissioner and attended the NQC's Training of Consumers on Quality.

The Wake Forest Baptist Medical Center (WFBMC) in Winston-Salem, North Carolina is a Part B, C, and D grantee. In addition, WFBMC participates in NC LINK, which is part of the multistate SPNS Systems Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative. Since it is also participating in the in+care Campaign, retention and re-engagement are very much on WFMBC's radar screen. To address this challenge WFMBC carefully reviewed their own data and processes and reached out to other providers in the state in an effort to re-engaged patients that had been lost to care.

WFBMC is a large provider, serving approximately 2,000 patients drawn from a multi-county service area. Many newly diagnosed patients gravitate to WFMBC but staff members also have observed that they lose a significant number of patients over time. To explore what happens to these patients, WFBMC implemented PDSA cycles for retention interventions as part of the NC LINK project. The first step was to generate a list of patients that had not been seen in 2 or more years but were still listed as active in CAREWare. Each patient was carefully researched and the results indicated that most of these patients were no longer receiving care with WFMBC-the vast majority of these due to death, relocation, or incarceration.

Once the inactive patients were removed from the system, a list of patients out of care for more than 9 months was developed. The first cycle generated a list of 70 patients targeted for outreach, which is conducted by patient navigators via phone calls, letters, Internet searches, etc. Once located, the navigators work with patients to address issues, such as transportation or unstable housing, which may be creating challenges to accessing care. Transportation has been identified as the most significant barrier to retention. The navigators also engage in extensive patient education-bridge counseling-that emphasizes the importance of remaining in care.

Since this intervention has been implemented, 436 patients have been target for outreach. Forty-two (42) percent of these hard-to-reach patients have been re-engaged in care at WFBMC. Twenty-seven (27) percent have been assigned a definitive case outcome (relocation, long-term incarceration, or death). The remaining 31 percent of patients were referred to the state health department for more extensive case finding efforts. Of these, 22 percent have been assigned a definitive outcome thus far, including 13 percent linked back to care at WFBMC.

While there are four patient navigators dedicated to bridge counseling, the emphasis on re-engagement has had an impact across staff and the entire patient population.

"The bridge counseling process is sending a message to both staff and patients," says Jennifer Keller, WFBMC's Clinical Quality Administrator. "Our staff is now consistently delivering the message to patients that remaining in care is essential to their well being. On a monthly basis, we now see more patients retained in care."

Many grantees have a network of providers that help them deliver Ryan White Program services to clients. Grantees are required to conduct quality improvement activities and that includes QI activities with their subgrantees.   This month's call will focus on how that is done by grantees funded under different Parts of the Ryan White Program. The call will consist of a series of presentations by grantees on how they have accomplished this as well as strategies to assist you in your QI effort.

National TA Call

October 17, 3:00-4:30 pm ET

Access the Webinar | Click here

To access the audio portion, dial 866-394-2346 and passcode 3971546368