Family Health Centers of San Diego (FHCSD) is a federally qualified health center (FQHC) that has been providing health care services since 1970. The agency currently offers services out of 35 sites, including 18 primary care clinics. It is the largest provider of comprehensive HIV prevention, outreach, education, testing, and support services in San Diego County, CA, with over 2,000 HIV-infected patients currently receiving care and support services.  FHCSD also provides individual and group level HIV prevention and harm reduction services, as well as HIV testing services county-wide.  Last year, FHCSD provided over 14,000 HIV tests, including more than 5,000 tests at over 70 residential substance abuse treat programs.

FHCSD, through a Part C or D grant, provides a comprehensive array of services to people living with HIV-including medical, mental health and dental care, as well as services to address issues that may act as barriers to retention in care, including case management and outpatient substance abuse treatment and risk reduction services. FHCSD also offers population-specific programs to meet the specific needs of underserved groups in the community, such as services for transgender individuals, homeless individuals and young gay men of color. Since opening their HIV specialty clinic in 1989, The Ciaccio Memorial Clinic, FHCSD has focused its efforts on the provision of high-quality services that meet the changing needs of the HIV community in San Diego. Since that time, the center's HIV-related services have continued to grow into a comprehensive system of care, all located within a several blocks radius. This "one-stop shopping" environment of care greatly enhances cross referrals by staff and completion of those referrals by patients.  It also supports direct and timely linkage to care for newly diagnosed or enrolled patients.

The Ciaccio Memorial Center  works hard to support patients to achieve better outcomes, with a focus on retention in care and adherence support. For example, to increase Pap smear rates FHCSD held a "Day of Beauty" event. HIV-infected women were invited to a 4-hour event where they were provided makeovers and also received Pap smears. Transportation and refreshments were offered to increase attendance. As a result, almost 70 percent of FHCSD HIV-infected female patients received a Pap smear this year, up from 32 percent the previous year. Other areas of focus for upcoming quality improvement projects include reducing wait times for appointments and reducing the number of missed appointments. In the near future, FHCSD will begin piloting a project to send text messages to patients to remind them of upcoming appointments.

FHCSD has participated in the NQC's regional group for the San Diego area and has worked with the NQC coach to build up their quality management program. In January, FHCSD hosted a Quality 101 training for other providers in the region.

"We rely on utilization and outcome data, as well as input from patients to identify opportunities for improvement," says Verna Gant, program manager for HIV support services. "Both our HIV Quality Committee and consumer advisory board each meet regularly to identify new quality improvement projects, establish goals and plans for improvement, and then review progress on current projects."

Another of FHCSD's projects, which focused on adherence and retention, has also paid off. Approximately 83 percent of patients have achieved viral suppression and 75 percent of patients have been retained in care.