2. Sustaining Primary Care-Public Health Partnerships
Peter DeMartino
Maryland Department of Health

3. Mission and Vision
MISSION The mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community- based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations. VISION The Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well-being.

4. The National HIV/AIDS Strategy
Achieving a more coordinated response

5. America in Miniature A diversity of regions and populations
A diversity of needs and service- delivery models

6. The Maryland Integrated HIV Plan
General Population
Community Mobilization
Marketing to a general audience
Vulnerable Population
PrEP and nPEP
Syringe Services
Behavioral Risk Reduction
HIV-informed Systems Integration
Condom Distribution and Promotion
Full Diagnosis
Routine Testing
Partner Services
Targeted Testing
Care Engagement
Linkage to Care/Data to Care
Expanded HIV Provider Network
Care Coordination
Peer Support Networks
Culturally Responsive and Flexible Workforce
Health Literacy
Viral Load Suppression
Medication Adherence
Access to Medications

7. Population-Level Data to Care Process
Analysis of eHARS data
Additional Database Searches
Data Sharing with LHDs
Internal LHD Record Searches
Provider Outreach
Client Outreach
Linkage to Care
Feedback to HIV Surveillance

8. Data Match with Health Center EHRs
Complete Data Match:
Not SHD’s first data match or OOC project
HCs have looked at patient lists internally
First data match with HC EHRs
Goal: Utilize resources more effectively to improve public health
Create more accurate lists of OOC
Activate the appropriate field staff – DIS, outreach, CHW, navigator, linkage specialist

9. Outcomes: More accurate, complete data
More efficient use of resources for patient follow-up
Improved relationships with health centers and local health departments
Aha! moment
More accurate, complete data:
New cases reported to HIV surveillance
Improved laboratory reporting
Health department data – appointment data, qualitative data
Health center EMRs corrected patients who were flagged incorrectly
Ongoing matches with HIV surveillance in other jurisdictions gives us better residency info
More efficient use of resources for patient f/u based on area of expertise:
Investment at SHD to clean and analyze data
Modernized the LHD referral process
May activate outreach f/u before patients fall OOC – otherwise activated at 12 months rather than 18
F/u is assigned based on who is more likely to reach the patient and help them re-engage
HCs are more sensitive to potential OOC – more recent OOC data
LHDs have the resources; are able to activate LTC/DIS quickly
Improved relationships with HCs and LHDs:
No project director during year 1
Project director hired in year 2 – What is our role?
We’re not the funder – That’s only one way to partner
Health centers and LHDs had an opportunity to learn about their partners’ area of expertise
A ha! Moment: William James, psychologist
P4C is a huge QI project
We will modify and replicate the match/CC model in other HD programs
Ryan White VL and pharmacy abandonment
Housing with HMIS

10. Quality Improvement Framework
Revisioning of RWHAP program monitoring and evaluation
20% of program officer position description is now data driven
Engagement of Surveillance in program activities
Informed by molecular surveillance cluster investigation process
Program and population level data
Measuring the impact of funded programs on population health

11. Data-Driven Early Intervention Services
Analysis of eHARS data
Additional Database Searches
Data Sharing with Funded Facilities
CAREWare
Unfunded
Provider Outreach
Client Outreach
Linkage to Care
RWHAP
Using the P4C case conference model
Linked back to Maryland Integrated Plan…
Driven by data either facility, population, or eHARS based
Broader in scope as EIS works with identifying undiagnosed individuals
Incorporating the EIIHA plan
EIIHA Defined: Identifying, counseling, testing, informing, and referring of diagnosed and undiagnosed individuals to appropriate services, as well as linking newly diagnosed HIV positive individuals to medical care. 
National EIIHA Goals 1. Increase the number of individuals who are aware of their HIV status 2. Increase the number of HIV+ individuals who are in medical care 3. Increase the number of HIV- individuals referred to services that contribute to keeping them HIV negative 
PHSA: Section 2617 (B) (5): 
(B) includes a strategy for identifying individuals who know their HIV status and are not receiving such services and for informing the individuals of and enabling the individuals to utilize the services, giving particular attention to eliminating disparities in access and services among affected subpopulations and historically underserved communities, and including discrete goals, a timetable, and an appropriate allocation of funds; (C) includes a strategy to coordinate the provision of such services with programs for HIV prevention (including outreach and early intervention) and for the prevention and treatment of substance abuse (including programs that provide comprehensive treatment services for such abuse); 

12. Maryland Department of Health Prevention and Health Promotion Administration 12