Transcript No Slide Title

Campaign Webinar
Migrants and Retention
September 25, 2013
1
Ground Rules for Webinar Participation
• Actively participate and write your questions into the
chat area during the presentation(s)
• Do not put us on hold
• Mute your line if you are not speaking (press *6, to
unmute your line press #6)
• Slides and other resources are available on our
website at incareCampaign.org
• All webinars are being recorded
2
Agenda
1.
2.
3.
4.
5.
3
Welcome & Introductions, 5min
Campaign Update, 5min
Migrant Clinicians’ Network, 35min
NO AIDS Task Force, 10min
Announcements, 5min
In the chat room,
Enter your:
1. name,
2. agency,
3. city/state, and
4. professional
role at agency
Campaign Update
4
in+care Campaign in 2014
•
•
•
•
•
•
•
Campaign database running through 2018!
Campaign website running through 2018!
Partners in+care Facebook maintained indefinitely
Campaign Newsletter moves to quarterly
Campaign Webinars move to quarterly
Partners in+care Webinars move to quarterly
Campaign Coaching integrates into NQC
Continuous TA Portfolios
• Local Retention Groups that wish to continue
meeting should do so – NQC will support where
possible
5
2013-2014 in+care Campaign
Activities
Activities
1-Campaign Webinar
2-Journal Club Webinar
3-Campaign Data Reporting Cycle by
Participants
4-Availability of Database Benchmark
Function
5-Improvement Strategy Cycle
6-in+care Website and Posting of
Updates
7-Campaign Newsletter
8-Partners Webinar
9-Partners in+care Facebook
10-Campaign Coaching Availability
11-Local Retention Group Availability
12-Case Study Drafting
13-Final Report Drafting
14-Communications with participants
around transition
6
2013
JUL
AUG
SEP
OCT
2014
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Reported Retention Interventions Nationwide
250
200
150
100
50
0
Entry Into and Education and
Retention in HIV Counseling
Care
Interventions
7
Health System Substance Use
and Service
Disorders
Delivery
Interventions
Children and
Adolescents
Non-IAPAC
Submit Improvement Updates!
8
IAPAC Guidelines –
Retention Improvement Ideas!
www.incarecampaign.org
9
Disseminating Improvement Work
Lightning Rounds!
• 1 or 2 slides that contain the most salient points of your
retention projects
• Include information on patient target, rationale for target selection and
baseline data from your measures (including the date)
• Include information on each improvement cycle (what was tried, what
was the result per the data) – for early cycles short measures of change
are not necessary, but add value!
• What are your conclusions? How are you sustaining improvement
• Simplicity and clarity are the idea!
10
Disseminating Improvement Work
Case Studies
• Help us tell your story!
• Campaign coaches are seeking longer, written stories about various
groups’ journey through the in+care Campaign
• Contact your Campaign quality coach if you are interested in sharing
your story!
• We are collecting 12 stories in total for publication
11
in+care Campaign webinar
September 25, 2013
Health Network
Ensuring continuity of care through
bridge case management
A force for health justice for
the mobile poor
Enrolled in Health Network 8/02
“Fernando” is a 56 year old 11/05
6/07
migrant farmworker diagnosed
with diabetes at age 49. He
traveled each year from South
Texas to Minnesota or
“wherever I can find work”
10/03
4/09
12/06
10/02
10/07
1/03
Over the ten years
Fernando
was
he
was enrolled,
Health
closedNetwork
out of
made
46 clinic
Health
contacts,
Network124
in
patient
contacts,
2013 because
transferred
he said that he
medical records 9
was no longer
times to 6
migrating.
different clinics.
8/1/2011
3/1/2011
10/1/2010
5/1/2010
12/1/2009
7/1/2009
2/1/2009
9/1/2008
4/1/2008
11/1/2007
6/1/2007
1/1/2007
8/1/2006
3/1/2006
10/1/2005
5/1/2005
12/1/2004
7/1/2004
2/1/2004
9/1/2003
4/1/2003
11/1/2002
6/1/2002
Fernando’s HBA1c While Enrolled in Health Network
15.00%
14.00%
13.00%
12.00%
11.00%
10.00%
9.00%
8.00%
7.00%
6.00%
10,000 constituents
Founded in 1984
Oldest clinical network
serving the mobile poor
Photo © Alan Pogue
MCN’s primary constituents
• Federally funded Migrant &
Community Health Centers
• State and local health departments
OUR MISSION
To be a force for justice in
healthcare for the mobile poor
In 1990 155 million people lived
outside their country of birth
United Nations, Department of Economic and Social Affairs, Population
Division (2009). Trends in International Migrant Stock: The 2008 Revision
(United Nations database, POP/DB/MIG/Stock/Rev.2008). and
U.S. Census Bureau, International Database.
In 2005 there were 195
million international migrants
3.1%
United Nations, Department of Economic and Social Affairs,
Population Division (2009). Trends in International Migrant
Stock: The 2008 Revision (United Nations database,
POP/DB/MIG/Stock/Rev.2008). and 2005 World Population Data
Sheet
In 2012…
United Nations' World Population Prospects: The 2008 Revision,
Highlights
“Whether I migrated from
the Limpopo to Gauteng
to look for work, or from
another country to South
Africa fleeing conflict or
in search of a better life,
or I fled into exile during
Apartheid to fight for
freedom, or sent my
children overseas to
study, you are, we are
and I Am a Migrant Too.”
Mobility Status - Movers
• Living in a different house at
the end of the period.
• Living in a different county,
state, region, or moving
from abroad.
• Moving within or between
central cities, suburbs, and
non-metropolitan areas of
the United States.
Photo © earldotter.com
Working definition
A Migrant is a person who:
• Crosses a prescribed
geographic boundary by
chance, instinct, or plan
• Stays away from their
normal residences
• Engages in remunerated
activity
Photo © Ed Zuroweste
Changes in
Migration
• New migration
patterns
• New populations
migrating to new
places
• Diversification of work
in the U.S.
24
Photo © earldotter.com
Agriculture has
traditionally been
one of the sectors
that has most
relied on migratory
labor
Migrant Health
Underserved population
whose health is challenged
by…
–Migratory lifestyle
–Cultural and language barriers
–Immigration status
–Inherent dangers and health
risks of occupation
–Lack of access to insurance or
financial resources
–Lack of regulatory protection
Photo © earldotter.com
TBNet
General
Health
Diabetes
Health
Network
HIV
Prenatal
Cancer
Health Network has established and maintained relationships with various
National Health Programs around the world
Health Network IMPACT
• Bridge between patients and their providers
• Fewer patients lost to follow up
• Higher % of patients completing treatment for
Active and/or Latent TB
• Higher % of patients with continuity of care for
chronic illnesses (DM, HTN, HIV)Treatment
completion reports
Barriers to Health Care
•
•
•
•
•
•
•
•
© Earl Dotter
Language / cultural differences
Understanding test results
Lack of health insurance
Cost of care
Legal status / fear
Incomplete numbers / addresses
Frustration over detention / journey
back home
Understanding treatment regimens
• Confidentiality is critical to all MCN staff and all
Health Network procedures conform to HIPAA
standards
• All patients are asked to sign (or have a witness
sign) a consent form before enrollment in Health
Network
Challenges to
Success
 Staff turnover at
clinics
 Patient Cooperation
 Identifying migrant
patients
 Incorrect patient
information
 Delay in enrollment
Ask Yourself…
• Who will follow these patients if the results come
back positive?
• How can these patients remain adherent while
moving to a different state / country?
• How can I get completion results for patients that
have started treatment?
Let HN work for you!
Our years of experience, a culturallycompetent team, and streamlined protocols
will provide you with solutions
To be successful,
consider these questions:
• Who will enroll / set-up interviews?
• How are faxes / other
communications going to be
handled?
• Which patients should be enrolled?
• What will be the timeline for
enrollment?
• What type of information is HN
going to need from the patient?
• How can I incorporate HN
enrollment into the routine
workflow?
© Earl Dotter
Health Network Enrollment Criteria
1
Patient is:
• Already mobile OR
• Likely to move
2
Patient has:
• HIV/AIDS
• Active or latent tuberculosis
• Diabetes/Hypertension
• Been tested for or is at risk for breast,
cervical or colon cancer
• Is pregnant and needing prenatal care
• In need of a clinic for follow-up of
Chronic condition
Educating patients
•
•
•
•
© Ryan K White
How HN works and how they will benefit from
participating (clinical support)
How to use HN
How HN keeps all patient information
confidential
The benefits, responsibilities and expectations
© Earl Dotter
Maintaining a Patient in Care
The Patient’s Role…
1. Provide HN with as many phone
numbers as possible
2. Contact HN after arriving to new
area
3. Stay on treatment until indicated
4. Inform HN of address / Phone
changes
5. Notify clinics of enrollment in HN
MCN’s Health
Network does not
discriminate on the
basis of
immigration status
and will not share
personal patient
information without
patient permission
Participant Benefits:
• A clinic / doctor / nurse is
waiting
• Updated records are
forwarded to clinic / patient
• Toll free number in the U.S.
and Mexico
• Better understanding and
diagnosis of condition
• Completion results stored in
patient file
• Patient confidentiality
© Earl Dotter
Forms Required for Enrollment
Consent Form
• Gives MCN staff legal
permission to transfer
participants’ medical records
and contact participants
• This form must have the
participant’s signature
• Valid if sent to HN staff within
5 business days of being
signed by patient, and
remains valid for 24 months
from the date signed
• Participants may renew their
consent after it expires if they
still need assistance
Patient Information Form
• It is critical to get as much
contact information as possible,
such as:
– Home, Cell, work numbers
(area codes)
– E-mail address
– Friends and family in
hometown
– family member who does not
move in US / other countries
that often/always knows
where they are, etc.
– person who will take a
message for you if we cannot
get in touch with you
Option 1
We Interview:
1. Simply have us interview the patient, we explain the program,
fill out the forms.
2. We will then fax the forms to you to have the patient sign
them.*
3. Then fax us the signed forms along with the patient’s medical
records.
*Please be ready to have the patient sign the faxed consent
form immediately after an interview.
Option 2
You Interview:
1. Fill out the information about the patient.
2. Have the patient sign the consent form and
provide all the contact information (must include
phone numbers).
3. Fax the signed forms and medical records to Health
Network staff
After Enrollment…
•
•
•
•
Once consent form received,
address will be verified
HN staff orients the patient
Obtain more contact
information
HN staff discusses next
steps with patient
Photo © Alan Pogue
Health Network
confidential fax
number
512-327-6140
Tools for Maintaining
a Patient in Care
Make sure patients have the HN toll free number:
800-825-8205
or
01-800-681-9508 if calling from Mexico
Continuous Quality
Improvement
•
•
•
•
•
Timed follow up with
patient / clinic
Completion rates
Number of clinic referrals
Review of cases
Periodic calls / e-mails with
facilities
–
–
Photo © Candace Kugel
How can we help
How can adapt our protocols
© Earl Dotter
Health Network Stories
HIV Case
Study
47 year old
Hispanic male
 Diagnosed HIV +
at an ICE facility in
Texas
 Enrolled in HN
 Moved to
California
 Diagnosed with
Kaposi’s Sarcoma
lesions and with
with Cirrhosis
(NASH-Nonalcoholic
Steatohepatitis)
Date
CD4 count
Viral Load
3/14/2011
183
139,005
4/12/2011*
294
138
10/7/2011
507
<40
3/15/2012
450
<40
6/8/2012
650
<40
2/26/2013
795
<40
*ART started
3/23/2011
20 clinic contacts
41 patient contacts
200 pages of Medical Records sent to HN
on 5 separate occasions from two health
centers
Class 3 Active TB Treatment
Results 2005-2011.
1,145 Class 3 Active TB Cases Referred
34 treatment not recommended by destination
country
1,111 Treatment Recommended
13 deceased
1,098 Followed by TBNet for Active TB
112 lost to follow up
64 refused treatment
922 Complete Treatment = 84.0%
Continuity of Care Worldwide
June 2010 patient contacts
Medical records sent to clinic
TBNet from the east coast
by TBNet and patient started
having been released by
on 4 drug regimen using DOT
coyotes”
Enrolled
in 2010
TBNet
February,
March,
2010
TBNet
prior toinofbeing
notified
• Screened
anpositive
ICE
deported
Central
facility
culturetoresults
• Negative
smear
America
• • RUL
consolidation
Clinic
found
2010
patient calls
• •September
TST
20 mm
Appointment
made
to say
he had
moved to
• •TBNet
Asymptomatic
Medical
records
transferred
eastprevious
coastnot
state
• another
Medication
was
from both
clinics
• started
Patient resumed DOT
• Wife
in Central
America
Medical
records
sent
updated
his country
progress
to his on
home
and family notified
May 2010, wife calls TBNet to say
TBNet
TBNet
case
then
manager
callsheld
aand
human
is able
that
herstaff
husband
isinitiates
being
by
to
trafficking
speak to
the
tovia
explain
ICEthe the
“coyotes”
oninvestigation
thepatient
west coast
of
need for
treatment
United
States.
Bridge Case
Management for you
Contact Us
• Health Network telephone:
800-825-8205 (U.S.)
01-800-681-9508 (from Mexico)
• Health Network fax: 512-327-6140
• MCN website: http://www.migrantclinician.org/
• If you have additional questions about the program, you may
also contact
Ricardo Garay: 512-579-4508 or
[email protected]
Contact
© Candace Kugel
Ed Zuroweste, MD 814-238-6566
[email protected]
Assisting HIV+ Undocumented, Monolingual Spanish
Speakers
in their Healthcare Transition from the United States
to Central America: A Case Study
NO/AIDS Task Force in New Orleans: An Overview
• Services for Spanish speakers
• Services for undocumented individuals
What happens when an HIV+ person is deported?
• HIV/AIDS is not a reason to be granted asylum
• (In)accessibility of HIV medicine and treatment in Central America
The importance of a coordinated transition from the US to Central
America
• Language barriers
• Uncertainty upon arrival
• Accessibility of HIV treatment and medicine
Transitioning from New Orleans to Honduras:
The Case Study
1.
1/8/13-Client switched from Truvada & Isentress to Atripla.
2.
1/17/13-MCN referral completed and faxed, medical records
requested at NATF, ADAP approves client for a 3 month vacation
supply of Atripla.
Successes?
3.
1/25/13-NATF speaks with MCN on the phone, they arrange to
call husband and to perform records request from NATF.
Failures?
4.
MCN speaks to the patient's husband, they are unaware of
health services in Honduras.
Lessons Learned?
5.
MCN contacts Health Ministry where a clinic and clinician is
assigned (based on the patient's address and health condition).
6.
A clinic referral is done and the patient and her husband are
notified of the clinic and clinician that will follow this case.
7.
The patient has a scheduled appointment on 4/8/2013. Blood
work is done and patient continues under treatment.
8.
Patient continues to receive treatment and is still awaiting
appointment/call back from embassy.
Health Network continues to follow-up with patient and clinic.
9.
Announcements
65
Upcoming Deadlines and Topics
•
•
Upcoming Webinars

Women and Retention | Christie’s Place | September 26 at 3pm ET

Partners in+care |’ Positive Women’s Network USA | October 8 at 1pm ET
Campaign Monthly Topics:
― October Topic – New Patients and Retention
― November Topic – Retaining Trans Patients in HIV Care
 Journal Club | Baligh Yehia | November 12 at 2pm ET
66
•
Data Collection Submission Deadline:
October 1, 2013
•
Improvement Update Submission Deadline:
October 15, 2013
Campaign Headquarters:
National Quality Center (NQC)
90 Church Street, 13th floor
New York, NY 10007
Phone 212-417-4730
[email protected]
incareCampaign.org
youtube.com/incareCampaign
67