Transcript Slide 1

in+care Campaign
Webinar
December 7, 2011
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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
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Agenda
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Welcome & Introductions, 5min
Stories from the Field, 10min
Data Integrity Maintenance, 15min
Review of December Campaign Data, 15min
Stories from the Field, 10min
Q & A Session, 5min
Project CONNECT
James Raper, DSN, CRNP, JD, FAANP,
FAAN
Associate Professor of Medicine & Nursing
University of Alabama at Birmingham
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UAB 1917 Clinic: Linkage to care
• Problem identified: Scheduled new patient visits often
not attended (“no show”)
• Study of patients calling to establish HIV care at UAB
1917 Clinic, 2004-2006
• 31% of patients (160 of 522) failed to attend a clinic
visit within 6 mos. of initial call
Mugavero et al. Clin Infect Dis 2007;45:127-130
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Project CONNECT
• Program launched January 1, 2007
• New patients have orientation visit within 5 days of their initial call to the
clinic
• Semi-structured interview, psychosocial questionnaires & baseline labs
• Uninsured patients meet with clinic SW
• Prophylactic antibiotics initiated more quickly
• Expedited referral for SA / MH services
• Interview
• Predisposing factors: Education, Income
• Enabling factors: Insurance, Transportation, Housing, Social support,
Spirituality, Stigma
• Contextual factors: Dependant care, Recent incarceration, Intimate
partner violence
• Perceived barriers to HIV care
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CONNECT: Program Evaluation
Time Period
“No Show”
Unadjusted OR
(95%CI)
Adjusted
OR (95%CI)a
Pre-CONNECT (n=522)
30.7%
1.0
1.0
Post-CONNECT (n=361)
17.7%
0.48 (0.35-0.68)
0.54 (0.38-0.76)
a
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Multivariable model controls for age, race, sex, insurance, location of residence and
time from call to scheduled visit.
Data Integrity
Maintenance
Anne Rhodes
Services Analyst, HIV Care Services
Virginia Department of Health
Terri Fox, MSW
Research Analyst
Rutgers University, School of Social Work
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Anne Rhodes
Services Analyst, HIV Care Services
Virginia Department of Health
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Quality Management Tools
Provider
Data Systems
(CAREWare, other)
Chart
Reviews
Client
Surveys
State Data Systems
(Medicaid, eHARS,
CTS, Labs, etc.)
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Barriers to Use
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Measures
Gap
Measure
Visit
Frequency
Newly
Enrolled
Healthy
persons?
Requires 2
years of data!
Labs/scripts
only?
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Issue of
those never
getting to
care
Viral Load
Suppression
Outcome
measure,
others are
process
measures
Only looks at
those with
medical visits
Retention Global Issues
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Current Retention Measure: 2 or more visits at
least 3 months apart
* Source: Virginia Client Reporting System (VACRS)
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Current Work in Virginia
• Discussion with DIS and CBOs funded for testing
to set up consent process
• Programming all retention measures into VACRS
• Matching with state surveillance/ obtain other
sources of care markers (Medicaid, Medicare, labs)
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Terri Fox, MSW
Research Analyst
Rutgers University, School of Social Work
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NJ Data Integrity Maintenance
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2.
3.
4.
5.
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Make the data a priority by using it
Infuse data expectations in contract language, regular reporting,
and outcome evaluation
Work with a diverse group of staff/providers/consumers
(depending on your ‘program’ unit) to ensure common
understanding of definitions of services, units and realistic
outcomes
Get the input from all parties involved about what goals for
service should be
Commit to working towards the stated goals
NJ Data Integrity Maintenance
6.
7.
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Ensure that the scope isn’t too broad; the focus and
amount of data should be narrow—(what do we fix first? );
where there are too many variables, each one gets a little
lost to someone, diluting the potential for impact
When there is a question of the integrity of the data, there
MUST be a follow up to address the data issue. Do NOT
accept ‘there is a problem with the data’ as the end of the
discussion. Next steps should always be to address said
‘data’ problem
NJ Data Integrity Maintenance
8.
Identify data champions at each site; a data champion
understands the local service system and how service
information is translated into data points in whatever
software/form/chart that you are using
9. Include the data champions in any and all discussions about
data, especially where the program manager may not be as
data savvy as the nurse, case manager, etc.
10. Check the data on a regular basis- does it look like the
levels of service are being met- how are the outcome
variables? What is the quality of care as expressed by the
data?
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NJ Data Integrity Maintenance
11. Train annually. This never hurts anyone. You can even let
your champions participate in training new/newer staff
12. Do NOT make data entry overly complicated. There should
be no translation/interpretation needed from contact sheet
to database
13. Make realistic goals for care. Do not set providers up to fail.
(Meet providers where they are- take steps towards
achievable goals)
14. Communicate that data are part of care; not an addition to
care
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Review of December
Campaign Data
Michael Hager, MPH MA
NQC Manager
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Data Review – Measure 1: Gap
Data Points:
• 85 organizations submitted data
• 54,256 patients in sample
Data Results:
• 16.16% patients experienced gap in care
• Top 10%: 2.85%; Top 25%: 4.60%
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Data Review – Measure 2: Visit Frequency
Data Points:
• 59 organizations submitted data
• 34,508 patients in sample
Data Results:
• 60.43% patients retained in care for 2 yrs
• Top 10%: 88.60%; Top 25%: 85.93%
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Data Review – Measure 3: New Patients
Data Points:
• 76 organizations submitted data
• 5,021 patients in sample
Data Results:
• 61.5% new patients retained in care for yr
• Top 10%: 99.98%; Top 25%: 89.96%
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Data Review – Measure 4: Viral Suppression
Data Points:
• 77 organizations submitted data
• 56,094 patients in sample
Data Results:
• 70.33% patients virally suppressed at last
viral load test
• Top 10%: 86.90%; Top 25%: 82.58%
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December Campaign Data
What have you learned?
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Retention and Viral
Suppression
Theresa Rubin, MA, MPhil
Quality Coordinator, AIDS Care Unit
North Carolina Department of Health
& Human Services
[[email protected]]
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Looking at Viral Load
• NC has 95 counties in Part B Program
• 8,201 Part B Clients for April 1, 2010 to March 31,
2011
• All subgrantees and their contractors required to use
CAREWare
• Viral Load data are for all HIV+ clients
• 91% had at least 1 Viral Load test
• Suppression was defined as VL ≤ 100
• We will be using VL ≤ 200 for the future
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Viral Load by Gender
100%
80%
63%
57%
male (n=5397)
female (n=2747)
68%
60%
40%
20%
0%
Detectable
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Missing
transgender
(n=57)
Undetectable
Viral Load by Age
100%
80%
58%
44%
56%
63%
66%
73%
40-49
(n=2898)
50-59
(n=2203)
60+
(n=657)
60%
40%
20%
0%
13-19
(n=92)
20-29
(n=758)
30-39
(n=1510)
Detectable
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Missing
Undetectable
Viral Load by Race/Ethnicity
100%
80%
46%
57%
60%
72%
70%
White
(n=2273)
Hispanic
(n=527)
40%
20%
0%
Black
(n=4970)
Detectable
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Missing
Other
(n=431)
Undetectable
Viral Load by HIV Risk Factor
100%
80%
60%
60%
66%
62%
HETERO
(n=3865)
MSM +
MSM/IDU
(N=3033)
IDU (n=563)
51%
40%
20%
0%
Detectable
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Missing
Other
(n=740)
Undetectable
Viral Load for MSM+MSM/IDU by
Race/Ethnicity
100%
80%
57%
60%
75%
69%
72%
WHITE
(n=1342)
HISPANIC
(n=166)
Am .
Ind/Other
(n=37)
40%
20%
0%
BLACK
(n=1393)
Detectable
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Missing
Undetectable
Time for Questions
and Answers
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Introducing Campaign Office Hours
• Purpose: directly communicate with NQC staff and
consultants
• ask general questions
• request technical assistance
• engage in dialogue about the Campaign.
• Details: Mondays and Wednesdays from 4pm-5pm ET
• Conference Call #: 866-394-2346
• Participant Code #: 4182576142#
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Next Steps
• First Data Collection Submission Deadline:
December 15, 2011 (Deadline Extended)
• First Improvement Update Submission Deadline:
December 15, 2011
• Office Hours: December 7/12/14/19/21
4pm-5pm ET
• January Webinar: TBA
• Meet the Author – Dr. Thomas Giordano:
January 12, 2012 at 12pm ET
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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
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