1. 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

2. 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)

3. 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…

4. 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

5. 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

6. % 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

7. Measuring Our Collaborative Progress

8. 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??

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Measuring the effectiveness of interventions Examples from the field

16. Improving enrollment of HIV patients in care using continuous quality improvement, Uganda
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.

17. 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
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

18. 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

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

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

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

22. 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

23. Thoughts/questions/comments on NY Links Evaluation?
Denis Nash
Diane Addison