1. 11 Campaign Webinar State Approaches to New Patient Retention December 4, 2013

2. 22 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. 33 Agenda 1. Welcome & Introductions, 5min 2. Campaign Update, 10min 3. Ohio Part B Program, 40min 4. Announcements, 5min In the chat room, Enter your: 1. name, 2. agency, 3. city/state, and 4. professional role at agency Michael Hager, MPH MA NQC Manager, in+care Campaign Manager New York, NY

4. 44 Campaign Update

5. 55 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

6. 66 2013-2014 in+care Campaign Activities 20132014 ActivitiesJULAUGSEPOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC 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

7. 77 Submit Improvement Updates!

8. 88 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!

9. 99 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

10. 10 Gap Measure Results (12/11 – 12/13)

11. 11 Visit Frequency Measure Results (12/11 – 12/13)

12. 12 New Patients Measure Results (12/11 – 12/13)

13. 13 Viral Load Suppression Measure Results (12/11 – 12/13)

14. L INKAGE F ROM HIV T ESTING T O HIV C ARE

15. Definition  Linkage: The process of connecting a client from one service system to another, in this case from HIV testing to HIV care. LTC = Linkage To Care

16. Why is this important?  Reduce HIV transmission by connecting newly diagnosed individuals to medical care as soon as possible after diagnosis; and  Connect more PLWHA with HIV-related medical and support services to improve their health; and  Facilitate a coordinated system of services from HIV prevention and testing to HIV care.

17. Systems Involved in Providing Linkage

18. Measure of Successful Linkage  90% of persons testing HIV+ will be referred to LTC.  80% will be linked to medical care within 90 days of testing positive.  Successful linkage from testing to medical care is defined by the client attending the initial visit at a medical setting with a HIV care provider.

19. Polling Question! What proportion of your newly diagnosed people with HIV are linked to care?  0%-25%  26%-50%  51%-75%  76%-100%  I’m not sure

20. Polling Question! What percentage of your clients who are linked to HIV care are retained in care (2 or more visits in the first year after linkage)?  0%-25%  26%-50%  51%-75%  76%-100%  I’m not sure

21. Linkage Roles & Responsibilities  HIV Test Counselor  Disease Intervention Specialist  HIV Prevention LTC Coordinator  Staff at HIV Care Agency

22. LTC Client Pathway

23. LARHC Linkage and Re-Engagement in HIV Care How are we going to capture all these LTC activities?

24. Overview of systems involved  The project will work with 3 existing systems, eHARS, CareWare and ODRS. eHARS CareWare ODRS Patient

25. Goals of LARHC  To have a registry of everyone living with HIV to provide Linkage to Care And Re-Engagement in Care Services.  To have a place to store data related to LARHC.  Have the ability to create reports from unified data.  Store new information related to patient/case.

26. Solution 1 for LARHC  Extract information from CareWare and eHARS, merge into ODRS and view consolidated info using ODRS GUI eHARS CareWare ODRS ODRS GUI

27. Pros/Cons of Solution 1 PROS:  Creates a central datastore for all information from eHARS and CareWare.  Information can be viewed using existing ODRS GUI. CONS:  Complicated ODRS system.  Introducing new functionality into ODRS might create new issues.  Information is not current (eHARS, CareWare).

28. Solution 2 for LARHC  Create a new subcomponent in ODRS called LARHC and provide views into eHARS and CareWare. eHARS CareWare view ODRS system LARHC

29. Pros/Cons of Solution 2 PROS:  Provides views into external eHARS and CareWare systems.  Information can be viewed using existing ODRS GUI. CONS:  Complicated ODRS system.  Introducing new functionality into ODRS might create new issues.

30. Solution 3 for LARHC  Create a new application independent of ODRS that can satisfy all the needs of LARHC. eHARS CareWare ODRS LARHC GUI LARHC view

31. Pros/Cons of Solution 3 PROS:  Creates real time views into external systems.  Does not involve extraction/transformation/loading external data into ODRS.  Provides ability to report data from various disparate systems for reporting purposes.  Allows Care Management specific information to be stored. CONS:  Dependent on external systems to show data.

32. Components of Solution 3 LARH C Mapping Query / Search Reporting Administration Care Management

33. Challenges  LTC coordinators in place before protocols / IT system  Distinction between role of LTC coordinator, DIS and case manager  Patient confidentiality for long-term follow- up

34. Successes  During first six months of 2013, 94.5% (411/435) of newly identified, confirmed HIV-positive clients were referred to medical care.  During first six months of 2013, 64.6% (281/435) of newly identified, confirmed HIV-positive clients attended their first medical care appointment within 90 days of the confirmed HIV-positive test date.  HIV/STD Prevention, HIV Care, and HIV/STD Surveillance programs working collaboratively.

35. Special Thanks  Elizabeth Cross – ODH HIV, STD, TB & Hepatitis Surveillance Program Administrator  ODH HIV & STD surveillance epidemiologists  ODH HIV Care staff  Local health department staff  ODH Office of Management Information Systems staff

36. Contact Information Jen Keagy, MPH, CHES HIV/STD Prevention Program Administrator  466-3173  Jen.Keagy@odh.ohio.govJen.Keagy@odh.ohio.gov Jill Garratt HIV Prevention Monitoring & Evaluation Coordinator  728-0877  Jillian.Garratt@odh.ohio.govJillian.Garratt@odh.ohio.gov

37. 37 Announcements

38. 38  Upcoming Webinars: ―Partners in+care Webinar | SPNS Projects Examine Retention in+care for HIV-Infected Transgender Individuals Thursday, December 10, 2013 | 2pm ET  Data Collection Submission Deadline: February 3, 2014  Improvement Update Submission Deadline: December 16, 2013  December, 2013 Campaign Topic Digital Health and Retention in+care Upcoming Events and Deadlines

39. 39 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