1. 1 Meet the Author Webinar May 10, 2012

2. 2 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

3. 3 Agenda Welcome & Introductions, 5min Meet the Author: Dr. Amy Sitapati, 30min Q & A Session, 20min Campaign Next Steps, 5min

4. BRINGING RETENTION INTO THE HIV PATIENT CENTERED MEDICAL HOME Amy M. Sitapati, MD Associate Director, Owen Clinic Associate Clinical Professor, Department of Medicine UCSD ANCHOR: A Novel Centered Home Optimizing Retention

5. Tell Us About Your Site – Question 1

6. Bibliography 1.Kurt C. Stange, Paul A. Nutting, William L. Miller, Carlos R. Jaen, Benjamin F. Crabtree, Susan A. Flocke, and James M. Gill Defining and Measuring the Patient- Centered Medical Home. J Gen Intern Med. 2010; 25(6):601-12. 2.Mallory O. Johnson. The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment. Am J Public Health. 2011;101:265-270. 3.David W. Bates and Asaf Bitton. The Future of Health Information Technology in the Patient Centered Medical Home. Health Affairs. 2010;29(4):614-21. 4.http://www.ncqa.org

7. Who are we? The OWEN CLINIC  Funded by California HIV/AIDS Research Program (CHRP) to serve as a pilot center for application of Patient Centered Medical Home in HIV  Site based focus to improve Retention University of California, San Diego 20 years of experience 3,000 HIV/AIDS patients High proportion of Medi-Cal/ Medicare/ RW funding

8. Goal of presentation: To illustrate how to begin to construct the concepts of a patient centered medical home into HIV primary care retention

9. Some of our patchwork homes, need upgrading maybebymonday.com/cars3

10. Step 1: Belief that change will help National Committee for Quality Assurance Patient-Centered Medical Home “The comprehensive and coordinated care that the medical home promotes leads to better health, longer lives, higher patient satisfaction and less expensive care. The question isn’t whether we should implement the medical home, but how. NCQA standards clearly assess and identify effective medical homes.” Paul Grundy, MD, IBM Global Director of Healthcare Transformation and President, Patient-Centered Primary Care Collaborative (PCPCC) http://www.ncqa.org/Portals/0/PCMH%20brochure-web.pdf

11. David W. Bates and Asaf Bitton The Future Of Health Information Technology In The Patient-Centered Medical Home Health Affairs, 29, no.4 (2010):614-621

12. Framing the PCMH http://www.vermonttimberworks.com/Web-Photos/Post-And-Beam/

13. THE MODERN MEDICAL HOME Communications multidirectional between provider-patient-and all the between.

14. Step 2: How to conceptualize concepts of PCMH Core Frames of the building REGISTRY Define patients with specific condition (i.e. HIV) while also specifying their disease status (6 month gap in care, poor viral control, etc.). Best practice would be to have non MD identify, communicate and track with an actionable intervention. CLINICAL DECISION SUPPORT Computerized system aiming to improve decision making around the diagnosis (clinical prediction), prevention and disease management (routine care reminder), and treatment. Bates, Health Affairs, 2010.

15. Martin is due for his routine care… But, we didn’t recognize that he was poorly retained. CARE MANAGEMENT (evidence for q 6 mo. visit) The database is searched using registry For the practice, and patients with gaps of 6 months are loaded into a tracking access Program.

16. A retention specialist uses TEAM CARE with tracking database for information about contact, last visit, primary provider and contacts patient. OPEN ACCESS SCHEDULING: Allows for scheduling in less than 2 week notice

17. Tell Us About Your Site – Question 2

18. Patient returns to care, and provider needs electronic record to help facilitate the quality care Provider View Manageable appointment schedule Clinical decision support Secure communication with patient Priority notification of abnormal lab results Help patient establish health care goals

19. Provider & health team related EMR improvements Decision support improvements, prevention health maintenance Provider report card Improved communication methodology (urgency, type)

20. Where we’re heading in modern POPULATION MANAGEMENT

21. Actionable reports in the EMR will make it possible evaluate: are my Hypertensive patients on two-drug therapy? (HIVQUAL measure) --and generate orders per protocol --and communicate with patient (letters, phone lists or MyChart)

22. Step 3: Patient empowerment in the PCMH PATIENT SELF CARE SUPPORT AND RESOURCES Health Care Empowerment Engaged Informed Collaborative Committed Tolerant of uncertainty “Engagement in health care has been identified as an important factor related to optimization of health outcomes.” MO Johnson, Am J Public Health, 2011

23. Patient centered technology supports patient and provider Manageable appointment schedule Clinical decision support Secure communication with patient Priority notification of abnormal lab results Help patient establish health care goals Schedule/Reschedule appointment Learn about support tools and programs Ask a medical question Learn about my condition View my lab results Get reminders of health care tests Set and track my health goals Clinic Based Web Page MyChart / MyChart Mobile Electronic Medical Record

24. Offer improved patient health literacy and systems literacy Clinic based web page Offer basic computer training Enhanced computer access (care service sites)

25. Enhance patient chart access MyChart: –Spanish translation –Providers strongly supporting patient initiation/use –Appt reminders –Test reminders (including specific to safety on meds) –Preventative care reminders/tracking

26. Tell Us About Your Site – Question 3

27. Step 4: Measure and Improve Performance Develop, apply, test, analyze and start over “The value of … primary care…includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities…” “The transformation …is best understood as a developmental process, with stops, starts, backslides, leaps and challenges…” This article nicely summarizes application of PCMH into primary care. Stange, J Gen Intern Med, 2010.

28. PCMH Review in HIV Primary Care 1.Open Access to continuity provider 2.Registry of HIV primary care patients 3.Apply poor retention as important quality goal 4.Improve patient empowerment through knowledge, chart access, etc. 5.Track patient’s return to care and coordination 6.Use lessons learned in CQI to make process more robust http://www.ncqa.org

29. Thanks to the OWEN ANCHOR TEAM: Moira Mar-Tang Militza Bonet-Vazquez Barbara Berkovich Pavel Tseytlovskiy Susan Benson Dorothea Northcutt Jan Limneos Dr. Chris Mathews CQI committee The California HIV/AIDS Research Program; Award number: MH10-SD-640

30. 30 Time for Questions and Answers

31. 31 Partners in+care Aspect of Campaign aimed at People Living with HIV and their allies What can they do to make sure they stay in care? What can they do to ensure their friends and loved ones stay in care? Handouts, Webinars, and Bulletin Board (coming soon) Partners in+care website is live! http://www.incarecampaign.net/index.cfm/77453 http://www.incarecampaign.net/index.cfm/77453

32. 32 Photo Drawing Prizes

33. 33 Campaign Office Hours: Mondays & Wednesdays 4-5pm ET Improvement Update Submission Deadline: May 15, 2012 Next Campaign Webinar: Retention & Youth May 31, 2012 2pm ET Next Partners in+care Webinar: Peer-to-Peer Retention May 24, 2012 2pm ET Data Collection Submission Deadline: June 1, 2012 Upcoming Events and Deadlines

34. 34 Campaign Headquarters: National Quality Center (NQC) 90 Church Street, 13 th floor New York, NY 10007 Phone 212-417-4730 incare@NationalQualityCenter.org incareCampaign.org youtube.com/incareCampaign