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in + care Campaign Meet the Author December 12, 2012

in + care Campaign Meet the Author December 12, 2012. 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)

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in + care Campaign Meet the Author December 12, 2012

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  1. in+care CampaignMeet the Author December 12, 2012

  2. 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. Agenda • Welcome & Introductions, 5min • Low-Effort Clinic-Wide Intervention to Increase Patient Retention In Care, 30min • Q & A Session, 20min • Updates & Reminders, 5min

  4. Preliminary Findings From CDC/HRSA Retention in Care Project Division of HIV/AIDS Prevention Centers for Disease Control and Prevention The findings and conclusions in this presentation are those of the presenters and do not necessarily represent the view of CDC or HRSA

  5. CDC Lytt Gardner, lead CDC investigator Gary Marks, Co-I Jason Craw, Co-I/study coordinator HRSA Investigators Faye Malitz, Robert Mills, Laura Cheever Mountain Plains AETC Lucy Bradley-Springer, Marla Corwin

  6. Objective • To identify clinic-based interventions to promote regular attendance for primary care and prevent loss to care

  7. Timeline For The Two Phases 6/09 6/10 6/11 6/12 |------------|------------|------------|-------------|-------------|------------|------------| ▼ PHASE 1 clinic-wide intervention ▼ PHASE 2 RCT enrollment ▼ 12-month intervention period begins, per enrollee, and monitoring of attendance ▼ After intervention ends, monitor attendance for 12 months, per enrollee

  8. Focus of The Talk Phase 1 • Brief description of methodology of clinic-wide intervention (Gary) • Findings and conclusions (Lytt)

  9. Phase 1: Features of Clinic-Wide Intervention • Theme: “Stay Connected for Your Health” • Provider messages about importance of regular care and keeping appointments • Working as a team • Keeping you healthy • Best possible care • Staying ahead of the virus • Brochure • Posters (waiting room, exam rooms)

  10. Comparison Strategy & Outcome Measures for Phase 1 Serial cross-sectional comparisons Pre-intervention period ▼ Intervention period 6/08 6/09 6/10 |---------------------|--------------------|--------------------|---------------------| Comparison strategy Of patients exposed to intervention in first 6 months, looked at behavior after exposure Compared with behavior of patients in pre-intervention period after they had an anchor visit in the first 6 months Outcomes (attendance from clinic databases) • % who kept two consecutive PC appts after exposure • Appointment adherence: proportion of scheduled PC appts kept (excluding appts cancelled ahead of time)

  11. Percent Who Kept Two Consecutive PC Appts After Exposure to Intervention

  12. Percent Keeping Next Two PC ApptsOverall

  13. Percent Keeping Next Two PC Appts by Number of Scheduled PC Appts

  14. Percent Keeping Next Two PC Apptsby Viral Load Status

  15. Percent Keeping Next Two PC Apptsby CD4 Cell Count

  16. Percent Keeping Next Two PC Appts by New/Re-engaging vs. Active Patients

  17. Percent Keeping Next Two PC Apptsby Patient Age

  18. Appointment Adherence: Proportion of Scheduled PC Appts Kept

  19. Mean Proportion of Scheduled PC Appts Kept

  20. Mean Proportion of Scheduled PC Appts Kept by Number of Scheduled PC Appts

  21. Mean Proportion of Scheduled PC Appts Kept by Viral Load Status of Patients

  22. Mean Proportion of Scheduled PC Appts Kept by CD4 Cell Count

  23. Mean Proportion of Scheduled PC Appts Kept by New/Re-engaging vs. Active Patients

  24. Mean Proportion of Scheduled PC Appts Kept, by Patient Age

  25. Limitations • Pre-post comparison with no concurrent control group • Patient exit surveys were not available during the pre-intervention period (no comparison)

  26. Conclusions • Low effort clinic-wide intervention contributed to a modest boost in attendance for PC • Stronger for “next two” (short term boost) • Waning effect for “visit adherence” (proportion of allappts kept in 12-month period) • Some small effects “significant” due to large N

  27. Conclusions • For both outcomes, effects stronger for some sub-groups: • New/re-engaging • Detectable VL • CD4 cell count < 350 • Younger patients (16-29) • Effect of # scheduled visits differed by outcome variable

  28. The Retention in Care Study Team Boston Medical Center Mari-Lynn Drainoni (PI) Cintia Ferreira Lisa Koppelman Roosevelt Lewis Maya McDoom Michal Naisteter Karina Osella Glory Ruiz Meg Sullivan (PI) SUNY Downstate Medical Center Sophia Gibbs-Cohen Elana Desrivieres Mayange Frederick Kevin Gravesande Susan Holman Harry Johnson Tonya Taylor Tracey Wilson (PI) Federal Laura Cheever, HRSA Faye Malitz, HRSA Robert Mills, HRSA Jason Craw, CDC/ICF-Macro Lytt Gardner, CDC Sonali Girde, CDC/ICF-Macro Gary Marks, CDC U. of Alabama- Birmingham Scott Batey Stephanie Gaskin Michael Mugavero (PI) Jill Murphree Jim Raper Michael Saag (PI) Suneetha Thogaripally James Willig Anne Zinski Baylor- Houston, TX Monisha Arya David Bartholomew Tawanna Biggs Hina Budhwani Jessica Davila Tom Giordano (PI) Nancy Miertschin Shapelle Payne William Slaughter Johns Hopkins Mollie Jenckes Jeanne Keruly (PI) Angie McCray Mary McGann Richard Moore (PI) Melissa Otterbein Liming Zhou U. Of Miami Carolyn Garzon Jesline Jean-Simon Kathy Mercogliano Lisa Metsch (PI) Allan Rodriguez (PI) Gilbert Saint-Jean Marvin Shika Mountain Plains AETC Lucy Bradley-Springer Marla Corwin

  29. Questions and Discussion

  30. Time for Questions and Answers

  31. Upcoming Events and Deadlines • Campaign Office Hours: Mondays & Wednesdays 4-5pm ET • Upcoming Webinars: • Optimal Wellness | Dec. 13, 2012 2pm ET • Sustaining Retention Projects in Unsure Funding Environments | Jan. 9, 2013 2pm ET • Mental Health & Retention | Jan. 10, 2013 2pm ET • How Can We Increase Initiation Of and Retention In Care Among Persons Living With HIV? | Jan. 30, 2013 2pm ET • Data Collection Submission Deadline: February 1, 2013 • Improvement Update Submission Deadline: December 17, 2012

  32. Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floor New York, NY 10007Phone 212-417-4730 incare@NationalQualityCenter.orgincareCampaign.org youtube.com/incareCampaign

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