Systems Linkages and Access to Care for

Populations at High Risk for HIV Infection in New York State

May 8, 2012

HRSA HIV/AIDS Bureau Special Projects of National Significance

Ground Rules for Webinar Participation

• Actively participate and write your questions into the chat area during the presentation(s)

• Discussion will occur throughout• 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 after

the webinar

Agenda

IntroductionsOpening RemarksWhat is the SPNS Initiative? How is the SPNS Initiative being implemented in NY?

• Statewide: NY Links• Upper Manhattan• Western NY

What is your role and key start up activities?Next steps

Opening Remarks

SPNS Overview

What are ‘SPNS’?

• Special Projects of National Significance– Part of the Ryan White HIV/AIDS Program and

administered by the HRSA HIV/AIDS Bureau– Aims to support the development of innovative models of

HIV care that respond to emerging needs of Ryan White clients

– Topics for SPNS funding prioritized by HRSA– Strong evaluation/research component to assess the

effectiveness of models, and then focus on the dissemination and replication of successes at a national level

SPNS Initiative – Systems, Linkages andAccess to Care

• Development of innovative and sustainable systemic models of linkage to improve access to and retention in quality HIV care

• Alignment of different components of the public health system, such as surveillance, counseling/testing, emergency rooms, mental health/substance use clinics, correctional health-care facilities (traditional and non-traditional providers)

• Alignment with National HIV/AIDS Strategy Goals:– Reduce number of people who become infected w/HIV– Increasing access to care and optimizing health outcomes – Reducing HIV related health disparities

Non-Engager Sporadic User Fully Engaged

Engagement in Care Continuum

[1] Health Resources and Services Administration, HAB. August 2006. Outreach: Engaging People in HIV Care Summary of a HRSA/HAB 2005 Consultation on Linking PLWH Into Care. [2] Eldred L, Malitz F. Introduction [to the supplemental issue on the HRSA SPNS Outreach Initiative]. AIDS Patient Care STDS 2007; 21(Suppl 1):S1–S2.

SPNS Initiative – Systems, Linkages andAccess to Care

• 4-year funding cycle awarded to high incidence states• Adapted approach of the Collaborative Model

developed by the Institute for Healthcare Improvement (IHI)

• Development of grantee-specific evaluation strategies to identify and document successful models

• Comprehensive multi-state evaluation led by a national evaluation center (UCSF – Janet Myers)

SPNS Initiative – Systems, Linkages andAccess to Care

• Overall goals for this initiative, consistent with National HIV/AIDS Strategy, are to: – increase the number of individuals who know their

serostatus– increase the number of newly diagnosed linked to HIV care

within three months of diagnosis– increase the number of individuals who are virally

suppressed– increase the number of people living with HIV retained

continuously in quality HIV care

SPNS Initiative – Systems, Linkages, andAccess to Care

• Timetable– RFA Announcement: March 2, 2011– Grant Application: April 4, 2011– Initiation of SPNS Grant: September 1, 2011; October, 2011; and WNY,

June, 2012– End of SPNS Grant: August 31, 2015

• SPNS Awardees: – New York – Louisiana– Massachusetts– North Carolina– Pennsylvania– Virginia – Wisconsin

NYS Links Overview

Together, we • identify innovative solutions for improving linkage to and retention in HIV care to support the delivery of routine, timely, and effective care for PLWHA in New York State; and

• bridge systemic gaps between HIV related services to achieve better outcomes for PLWHA through improving systems for monitoring, recording, and accessing information about HIV care in NYS.

NY Links Mission

Years 1 & 2 Collaborative Waves• Wave I: Upper Manhattan Regional Group and Western NYS• Wave II: 2 Collaboratives in NYC• Wave III: 2 Upstate Collaboratives

Years 3 & 4 Statewide Dissemination• Identification of Successful Linkage/Retention Interventions• Statewide Conference(s) to Promote Successful Interventions• Webinars, Conference Calls, etc.• Posting on AIDS Institute and other QI Websites

Timeline

Year 2 Year 3 Year 4

Collaborative Waves Statewide Dissemination

Data and Systems Integration

Year 1

SPNS Evaluation

Purpose: • to identify and address key issues and to effectively utilize already available data

sets (epi/surveillance, Medicaid, AIRS, etc.) to improve linkage/retention• to make these data sets accessible to frontline providers for quality

improvement efforts

Major Participants: • Denis Nash (lead) & Dr. Bruce Agins• Dennis Tsui (Medicaid)• Dr. Colin Shephard (NYCDOHMH Epi & Surveillance)• Mary Irvine (NYCDOHMH E-Share)• John Fuller (NYSDOH AIRS)• Dr. Lou Smith & Dan Gordon (NYSDOH Epi & Surveillance) • Eli Camhi (Metroplus) • Tom Moore (Healthix)

Data Subcommittee

• Blue-Clinical Program Participating in the Upper Manhattan Regional Group• Yellow-Supportive Service Program Participating in Upper Manhattan

Regional Group

Upper Manhattan Regional Group Collaborative

• Engagement of all medical and non-medical providers in the Upper Manhattan geographic area to improve linkage to and retention in HIV care (31 sites)

• Current Progress:– 3rd Learning Session: April 10th , 2012 – 1st Collection of Collaborative Measures:

April 2nd, 2012– 2 QI Workshops modified for linkage and

retention have been held• Next Steps:

– Test and evaluate provider-driven interventions

– Provide data measures technical assistance

Western NY Links Collaborative

• Western NY Links Collaborative - engagement of all HIV medical and non-medical providers in the Western NY geographic area, focusing on Rochester and Buffalo, to improve linkage to and retention in HIV care

[Upstate Learning Network – engagement of only HIV medical programs located in Binghamton, Buffalo, Elmira, Rochester, Syracuse and Utica to build capacity for quality management and to jointly improve patient care]

Western NY Links Collaborative• Current Status:

– Support and involvement of Erie and Monroe County DOH– List of participating providers developed– Planning Group established– Performance measures defined– WNY Collaborative materials drafted

• Next Steps:– Introductory Webinars– Pre-Work Webinars– Conduct Site Visits– Kick-off Collaborative Meeting: June 12, 2012

WNY Collaborative Teams by Zip Codes

As of April 26, 3012• Red-HIV programs participating in the

WNY Collaborative

WNY Collaborative Model and Dates

Webinars: • Introductory - May• Pre-Work• Site Visits

June 12

NY Links Performance Measures

NY Links Measures

The following measures will be collected and reported in aggregate by all NY Links

participating HIV clinical, general medical, and supportive service providers and should capture all patients/clients with a diagnosis of HIV/AIDS, regardless of age or funding source of services.

Measure Agency Type

Linkage All Programs that Conduct HIV Testing

Retention HIV Clinical CareNew Patient

Retention Clinical Engagement Supportive Services &

General Medical Assistance*

New Client Clinical Engagement

Brief Overview of NYS Links Measures

Performance Measurement Expectations

• Self reporting of NY Links measures every 2 months

• Submission of performance measurement data to NY Links online data basis (www.newyorklinks.org/database)

• Sharing of improvement activities• Next Webinar on Pre-Work and Site Visits will

provide more in-depth information

Collaborative Team

Collaborative Team• Identify a leader who will drive change, support quality

improvement activities, direct resources and facilitate communication within the organization in support of the agency specific NY Links activities

• Form a multidisciplinary team, including expert staff (data and evaluation, quality improvement, clinical providers, consumer involved in QI) to participate as a team in the WNY Collaborative

• Members of the Collaborative Team attend all learning sessions and champion linkage-retention activities in the agency

RolesIdentify key staff to fill the following potential

roles/responsibilities:• Senior Leader/Collaborative Lead• Point of Contact – person who can move QI project

ahead and coordinator• Data Manager• Clinical Provider• PLWHA

WNY Pre-Work Tools

Pre-Work ToolsThe Pre-Work was developed to help supportive and clinical providers to investigate linkage, retention, and possible opportunities for cross-agency improvements.

This activity will help your program to:• Review data systems/accessibility across your agency• Collect data on the performance measures• Identify common referral sources across the region• Identify areas for follow-up

Pre-Work ToolsEach participating agency will complete at least one or more of the following five Pre-Work Tools:

• Pre-Work Tool 1: HIV Linkage– All programs who offer HIV testing– One algorithm across the agency

• Pre-Work Tool 2A: Primary Care Global Retention– If your program provides HIV medical care

• Pre-Work Tool 2B: Primary Care New Patient Retention– If your program provides HIV medical care

Pre-Work Tools

• Pre-Work Tool 3A: Clinical Engagement - Supportive Services– If your program provides supportive services, complete

this algorithm across the agency inclusive of all supportive services

• Pre-Work Tool 3B: New Client Clinical Engagement - Supportive Services• If your program provides supportive services, complete

this algorithm across the agency inclusive of all supportive services

# of Active Patients

(HIV patients with at least one HIV primary care visit in the first six months (Jan-Jun)

of 2010)

# of Retained Patients

(HIV patients with HIV primary care visit(s) in the

second six months (Jul-Dec) of 2010)

# of Out of Care Patients

(HIV patients with NO HIV primary care visit(s) in the

second six months (Jul-Dec) of 2010)

Active Caseload

Not in Care Pool

Retention Follow-up Pool# of Patients who are

Incarcerated, Deceased, Moved, Receive HIV Care

Elsewhere

(HIV patients with documented reasons for being out of care)

# of Patients Incarcerated

(HIV patients not known to be scheduled for release in

jurisdiction in Jul-Dec of 2010)

# of Patients Deceased # of Patients who Receive Care at Another HIV Program or Moved

# of Patients who Require Follow-

up(HIV patients who are out of care with potential for

re-engagement)

# of Patients with Unknown Reasons for

Being Out of Care

# of Patients with Known Addressable Reasons for Being Out of Care

A=B+C

C=D+E

A

B C

D

E

F G HI

J

D=F+G+H E=I+J

Primary Care Agency Name

Completed By:

# of HIV Patients Deceased

C D

E I

B=C+D

A=B+E

A

NY Links Performance Measure 1 Tool: Linkage to Care Among Newly Diagnosed Persons

# of Newly Diagnosed HIV Patients

Newly diagnosed HIV patients with positive confirmatory test from Dec 1, 2011 to Jan 31, 2012

# of Patients Included

(Denominator)Newly diagnosed HIV patients with a positive confirmatory test from Dec 1, 2011 to Jan 31, 2012 who do not fit exclusion criteria in step [B]

# of Linked Patients (Numerator)

Newly diagnosed HIV patients who had their first HIV primary care visit within 30 days of the date of a confirmatory HIV test result that occurred between Dec 1, 2011 to Jan 31, 2012

B

E=F+I

HIV Testing Site Completed By

# of HIV Patients who Moved

# of Newly Diagnosed HIV Patients NOT Referred to HIV Primary Care Facility within 30 days

# of Newly Diagnosed HIV Patients Referred to but NOT seen by a HIV Primary Care Facility within 30 days

G

H

F=G+H

# of Newly Diagnosed HIV Patients who

Require Follow-upNewly diagnosed HIV patients with NO HIV primary care visit within 30 days of the date of a confirmatory HIV test result that occurred between Dec 1, 2011 to Jan 31, 2012

F

# of Patients ExcludedNewly diagnosed HIV patients with a positive confirmatory test from Dec 1, 2011 to Jan 31, 2012 who were Incarcerated, Deceased, Received Care Elsewhere, Moved between Dec 1, 2011 and Mar 1, 2012

MEASUREMENT PERIOD 3 Months

REPORTING PERIOD 2 months during which new diagnoses are

counted

30 days to allow linkage to primary care

SUBMISSION

DUE DATE

12/01/11 01/31/12 03/01/12 04/02/12

Engaged in Care by HIV Program

# of Clients in Care

HIV Primary Care Program

Referred/Not In Care by HIV Program# of Clients

ReferredHIV Primary Care Program

# of Active Patients

(HIV patients with at least one HIV primary care visit in the first six months (Jan-Jun)

of 2010)

# of Retained Patients

(HIV patients with HIV primary care visit(s) in the

second six months (Jul-Dec) of 2010)

# of Out of Care Patients

(HIV patients with NO HIV primary care visit(s) in the

second six months (Jul-Dec) of 2010)

Active Caseload

Not in Care Pool

Retention Follow-up Pool# of Patients who are

Incarcerated, Deceased, Moved, Receive HIV Care

Elsewhere

(HIV patients with documented reasons for being out of care)

# of Patients Incarcerated

(HIV patients not known to be scheduled for release in

jurisdiction in Jul-Dec of 2010)

# of Patients Deceased # of Patients who Receive Care at Another HIV Program or Moved

# of Patients who Require Follow-

up(HIV patients who are out of care with potential for

re-engagement)

# of Patients with Unknown Reasons for

Being Out of Care

# of Patients with Known Addressable Reasons for Being Out of Care

A=B+C

C=D+E

A

B C

D

E

F G HI

J

D=F+G+H E=I+J

Primary Care Agency Name

Completed By:

# of HIV Clients/Patients Incarcerated for greater than 90 days

# of HIV Clients/Patients Deceased

# of HIV Clients/Patients who Received Care Elsewhere

C D F

G

H

B=C+D+E+F

A=B+G

A

NY Links Performance 3A: Clinical Engagement Measure

# of Active HIV Clients/Patients

HIV positive clients/patients who had a supportive service visit/ general medical encounter from Jan 1, 2012-Mar 1, 2012

# of Patients Included

(Denominator)HIV positive clients/patients who had a supportive service visit/ general medical encounter from Jan 1, 2012-Mar 1, 2012 who do not fit exclusion criteria in step [B]

# of Retained Patients (Numerator)HIV positive clients/patients who had a supportive service visit/ general medical encounter from Jan 1, 2012-Mar 1, 2012, who had at least one HIV primary care visit from Jul 1, 2011-Dec 31, 2011

B

G=H+I

Supportive Service or General Medical Assistance Agency

Completed By

# of HIV Clients/Patients who Moved

# of HIV Clients/Patients with Unknown Reasons for NO HIV Primary Care Visit

# of HIV Clients/Patients with Known Reasons for NO HIV Primary Care Visit

J

K

I=J+K

# of Active HIV Patients who Require Follow-up

HIV positive clients/patients who had a supportive service visit/ general medical encounter from Jan 1, 2012-Mar 1, 2012 with NO HIV primary care visit from Jul 1, 2011-Dec 31, 2011

E

I

# of Patients ExcludedHIV positive clients/patients who had a supportive service visit/ general medical encounter from Jan 1, 2012-Mar 1, 2012 who were Incarcerated, Deceased, Received Care Elsewhere, Moved between Jul 1, 2011-Mar 1, 2012

07/01/11

MEASUREMENT PERIOD 12 Months

REPORTING PERIOD 2 months: HIV clients/patients with a Supportive Service and/or General Medical visit

SUBMISSION

DUE DATEUp to 6 months prior: Review if client from the reporting period had a documented/self‐reported primary care visit

12/31/11 03/01/12

04/02/12

01/01/12

Site Visits

Purpose of Site Visit• Learn more about your agency and your participation in current HIV activities

and coalitions/networks• Meet with your staff who will be involved in the NY Links Initiative; including

representation from agency’s Primary Care, Supportive Service, HIV Testing, and Quality Management Programs

• Strengthen your agency’s understanding of the WNY Links Collaborative initiative• Components

– Complete a collaborative assessment– Address any questions regarding WNY Collaborative – Identify team members for NY Links collaborative participation– Follow-up on Pre-work for the next Learning Session

Site Visit Logistics• Site visit duration: 90-120 minutes• Each visit will be lead by a representative from

NYSDOH, Nanette Brey Magnani, and when possible, Steve Sawicki, NY Links Project Director and a representative from Regional DOH

• Site Visit Participation:– Executive leader(s), QI program coordinator, data/IT

coordinator• Aim to complete site visits by the 1st Learning Session

Collaborative Response Team

WNY Collaborative Response Team

A Response Team is a self-organizing, peer-driven group made up of 5-10 nominated leaders with various skill sets and roles who participate in the WNY Collaborative.

Purpose:– Streamline communication– Strengthen leadership capacity– Support & direct collaborative– Increase collaborative sustainability

Next Steps

Next Steps

• Repeat Introductory Webinar– Thu, May 10 at 10am

• Pre-Work Webinars (repeated twice)– Fri, May 11 at 2pm

• Scheduling site visits• Site specific pre-work activities• Kick-off Collaborative Learning Session

– June 12, 10:00am – 3:30pm at Mount Morris

Contact Information

Clemens Steinbock, Director of Quality Initiativescms18@health.state.ny.us

Steve Sawicki, SPNS Leadsvs03@health.state.ny.us

Cameron Stainken, Program Assistant with the SPNS Initiative (departing in June) crs05@health.state.ny.us , 212.417.4731

Nanette Brey Magnani, EdD, Quality Consultantbreymagnan@aol.com

Main NY Links Email: info@newyorklinks.org

Questions and Answers