UMRG 3rd Learning Session: July 19th, 2012 Measuring Our Collaborative Progress:  Linkage and Retention in Upper Manhattan Denis Nash, PhD, MPH Diane Addison, MIA, MPH CUNY School of Public Health UMRG 3rd Learning Session: July 19th, 2012

Outline of presentation Overview of NY Links Collaborative Measures Analysis of NY Links Collaborative data results for the Upper Manhattan Regional Group Using data to measure the effectiveness of improvement strategies (examples from the field)

NY Links Collaborative Measures Purpose of NY Links Collaborative Measures: For each team - to assess and support its internal linkage and retention efforts and bench-mark its performance with providers in the region and To measure the progress and impact of our collaborative efforts to improve linkage to and retention in HIV clinical care Frequency of reporting by sites: Every 2 months Submission dates: April 2, June 1, August 1, October 1, etc…

Upper Manhattan Regional Group (UMRG) site map and types of services provided Site type N (%) All UMRG participating sites 25 (100%) HIV clinical care + HIV testing + supportive services 16 (64%) HIV testing + supportive services 6 (24%) HIV clinical care + supportive services (no testing) 1 (4%) Supportive services only 2 (8%) Map: Blue dots indicate clinical sites and yellow dots indicate supportive service and testing sites. Data Source: Baseline site survey, updated: June 15, 2012

Brief Overview of NY Links Collaborative Measures Agency Type Linkage All Programs that Conduct HIV Testing Retention HIV Clinical Care New Patient Retention Clinical Engagement Supportive Services & General Medical Assistance New Client Clinical Engagement

% of UMRG sites reporting on collaborative measures # of sites that have submitted data # of sites expected to submit data % of sites reporting April 2012 June 2012 Linkage 17 14 22 77.3% 63.6% Retention 12 11 70.6% 64.7% New patient retention Clinical engagement 9 8 52.9% 47.1% New client clinical engagement 10 58.8% Total number of UMRG sites=25 Total number of participating UMRG sites: 25 Data Source: NY Links collaborative measures—through June 2012 submission, updated: July 11, 2012 6

Measuring Our Collaborative Progress

Data Analysis Questions to Keep In Mind What are our major findings . . . What is the frequency of patients not getting linked to and/or retained in care? Is this what you would expect? What is the impact of not being linked/retained in care? What is the feasibility that we can improve this? Can we set the bar higher??

UMRG: proportion of newly diagnosed clients linked to care within 30 days 17/22 sites 95 clients 14/22 sites Data Source: NY Links collaborative measures, updated: July 11, 2012

UMRG: proportion of patients retained in care 12/17 sites 5,975 patients 11/17 sites Data Source: NY Links collaborative measures, updated: July 11, 2012

UMRG: proportion of new patients retained in care 12/17 sites 757 patients 12/17 sites Data Source: NY Links collaborative measures, updated: July 11, 2012

UMRG: proportion of clients engaged in care 9/17 sites 629 clients 8/17 sites Data Source: NY Links collaborative measures, updated: July 11, 2012

UMRG: proportion of new clients engaged in care 11/17 sites 64 patients 10/17 sites Engaged: number of new clients/patients in the reporting period, without a documented HIV clinical care provider or visit upon enrollment, who had at least one medical visit with a provider with prescribing privileges within 30 days of enrollment in the supportive service program Data Source: NY Links collaborative measures, updated: July 11, 2012

UMRG summary of collaborative measures: percentage linked, retained or engaged in care, data through June 2012 % linked, retained, or engaged Data Source: NY Links collaborative measures, updated: July 11, 2012

Measuring the effectiveness of interventions Examples from the field

Improving enrollment of HIV patients in care using continuous quality improvement, Uganda http://www.hciproject.org/sites/default/files/Uganda_HIVcoverage-retention-outcomes_Feb2012.pdf IMPROVING COVERAGE, RETENTION, AND CLINICAL OUTCOMES OF HIV PATIENTS IN UGANDA USING CONTINUOUS QUALITY IMPROVEMENT Figure 2 shows the increase in enrollment of HIV-positive TB patients in chronic care made possible by changes such as escorting patients to the HIV clinic and assigning a focal person to verify that patients are enrolled in care. USAID Health Care improvement Project, “Improving coverage, retention and clinical outcomes of HIV patients in Uganda using continuous quality improvement”, February 2012.

Reducing missed appointments and number of lost clients through community tracking using peer clients and zoning to ease follow-up: Pallisa District, Eastern Uganda Intervention Intervention http://www.hciproject.org/node/3328 Reducing missed appointments and number of lost clients through community tracking using PHAS and zoning to ease follow-up”, Rotich Leonard, 2012 USAID Health Care improvement Project: “Reducing missed appointments and number of lost clients through community tracking using PHAS and zoning to ease follow-up”, Rotich Leonard, 2012

Comparing outcomes for different linkage and retention strategies in HIV care, example * * * * * p<0.05; adjusted for facility type, urban/rural, year clinic began ART services, and patient load M Lamb et al. PLoS One, 2012

Patient navigator intervention to increase screening colonoscopy, Lincoln Hospital Nash et al. J Urban Health, 2006

Patient navigator intervention to increase screening colonoscopy, Lincoln Hospital Nash et al. J Urban Health, 2006

Patient navigator intervention to increase screening colonoscopy, Lincoln Hospital Nash et al. J Urban Health, 2006

Next Steps Share data with your team/agency: - How does your linkage and retention performance compare with the collaborative? - How can/will your improvement efforts contribute the overall collaborative outcome? Intervention strategy Tracking Tool Sign up for check in-call through doodle Intervention Strategy Tracking Tool completed online Next submission due date: August 1, 2012

Thoughts/questions/comments on NY Links Evaluation? Denis Nash (dnash@hunter.cuny.edu) Diane Addison (daddison@hunter.cuny.edu)