National Quality Center (NQC)1 RW Grantees in Washington, DC Presentation “Recapture Blitz”

National Quality Center (NQC)2 Recapture “Pilot” at Family & Medical Counseling Services Objectives: Recognize barriers to care Identify customized solutions  Defined by staff  Defined by clients  Defined resources

National Quality Center (NQC)3 Overview of FMCS Statistics 1997  652 clients 450 active medical clients (unduplicated/year) Lost to follow up : 200* 2005  864 clients 687 active medical clients Lost to follow up : 122*  1100 clients  unduplicated medical clients  Lost to Follow up: 190* *(alive and well)

National Quality Center (NQC)4 Lost to Follow Up Client Identification Process Chart review Utilizing New EMR  Missing numbers on review  Missing from staff reports  Seen in Outreach  Request for Medical records Calls from other providers Hospital admissions

National Quality Center (NQC)5 Lost to Follow-up Contact Clients Identified as Lost to Follow-Up were contacted via: Telephone Outreach van Home visits Letters More telephone calls

National Quality Center (NQC)6 Patient Reported the Following Reason’s “Just stopped coming” “Problems with a staff member” “ don’t know” “Got tired of taking pills” Relapse Moved, so clinic too far Incarcerated

National Quality Center (NQC)7 Reasons Clients Returned Incentives  Gift cards  Food vouchers Needed to know we still cared Readiness for care Not treated as well in other places

National Quality Center (NQC)8 Target Outreach to Get Clients Back in Care Recapture Program Time: 4 months  Telephone contacts: 246 Many duplicate calls or repeat contacts  Outreach contacts: 97  Home visits: 30 lost adherence team secondary to funding so fewer home visits Case Managers/ Outreach team given comp day for 3 clients scheduled and met in med dept.

National Quality Center (NQC)9 Factors for Continued Growth 1. Adherence team  2 peer educators Follow up phone calls Abn lab letter Home visits 2. Medical CM /Outreach Adherence Team  Follow up phone calls  Home visits  Incentives for continued service

National Quality Center (NQC)10 Individualized Care Plan Optimize Care with Individualized Service  Make available : tokens, metro pass  Increase medical availability  Treat mental health issues  Simplify insurance criteria  Incentives  Close client contact on a daily basis  Reduce stigma  Develop social resolution strategy/support groups  daycare

National Quality Center (NQC)11 Key Factors to Successful Long Term Care Individualized care Face to face contact Reassurance Ease of service Stabilization Resolution of social barriers  Decrease homelessness  Decrease social stigma  Decrease co-morbid conditions

National Quality Center (NQC)12 Results After 4 Month Initiative 190 Initially lost to care 116 returned to care at FMCS 40 in other clinics 44 still lost  61 % recovery rate  82 % in care  23 % attrition Clinic continues to follow initiative protocol though no further funding for intensive work

National Quality Center (NQC)13 The District of Columbia Department of Health HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) has put an increasing focus on  Promotion and expansion of testing  Linkage to and re-engagement in care  Retention in care with improved health outcomes The “4Rs”  Recruitment/Navigation into care  Recapture  Retention and  Results

National Quality Center (NQC)14 Recapture Blitz 2009 In 2008 HAHSTA gave sub-grantees a mission to “Recapture” those lost to care Providers competed for MAI funds from HAHSTA to implement recapture activities FMCS developed an effective model that was identified as best practice In 2009 HAHSTA called for a “Recapture Blitz” to scale-up the model

National Quality Center (NQC)15 Recapture Blitz 2009 Two thirds of the major HIV public sector providers in DC participated in the Blitz This was a “Cross-Part” initiative, including providers that are all funded through Ryan White, but have a mix of A, B, C and D.

National Quality Center (NQC)16 Recapture Blitz 2009: Two phases 1.Identification and prioritization of the client cohort to be recaptured ( August 2009) a. Compilation of client lists by providers b. “Matching” against HAHSTA databases 2.Implementation of client contact and re- engagement in care ( September to December 2009)

National Quality Center (NQC)17 Recapture Blitz 2009 Providers compiled client lists using the definition as lost to care meaning out of care for 6 months or more up to 2 years  Some providers opted for > 2 years

National Quality Center (NQC)18 Recapture Blitz 2009 HAHSTA performed “Matching” against internal DOH databases using either the most recent lab test or “prescription fill date” Determined clients lost to care at a system level Prioritized which clients could be contacted first based on time out of care Clients were matched to the following datasets:  CDC HIV surveillance, ADAP and laboratory databases

National Quality Center (NQC)19 Recapture Blitz: Matching Results IndicatorNumberPercent Total clients submitted to HAHSTA as “lost” % Clients found to be active somewhere within 6 mos 89434% Clients found to be active somewhere over 6 mos 96136% Clients not found in databases 74028% Clients found to be deceased 472%

National Quality Center (NQC)20 Recapture: Matching Results Of 2642 thought to be lost by providers, 537 or 20% of the clients were seen by a different agency than who declared them lost. 20% of clients who providers thought were lost were actually seen somewhere else

National Quality Center (NQC)21 Recapture Blitz: Implementation Implementation of client contact and re-engagement in care ( Sep – Dec 2009) Providers used the revised list provided by HAHSTA to contact clients. They prioritized those active within 6 months, but also began to contact clients in the over 6 month category. To date, we have data from 5 providers and are still awaiting results from 3. The 5 providers had a total of 1365 clients lost to care.

National Quality Center (NQC)22 Recapture Blitz: Preliminary Data IndicatorNumberPercent Number of clients providers attempted to contact % Number of clients actually contacted 40441% Number of clients reported that they were already in care 23023% Number of clients who made appointments 18619% Number of clients who kept appointments ??

National Quality Center (NQC)23 Next steps Collection and analysis of ongoing and updated data Assessment and development of tools Providers need going forward Recapture Summer Blitz