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Outreach in SRO hotels

Outreach in SRO hotels. Chinazo Cunningham, MD Division of General Internal Medicine Dept of Family and Social Medicine MMC/AECOM. SRO hotels. HIV+ SRO Hotel Residents. Cunningham, AIDS Pt Care STDs 2005. Do HIV+ SRO hotel residents need outreach?.

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Outreach in SRO hotels

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  1. Outreach in SRO hotels Chinazo Cunningham, MD Division of General Internal Medicine Dept of Family and Social Medicine MMC/AECOM

  2. SRO hotels

  3. HIV+ SRO Hotel Residents Cunningham, AIDS Pt Care STDs 2005

  4. Do HIV+ SRO hotel residents need outreach?

  5. How accurate are self-reported HIV primary care visits? • Cross-sectional study of 522 HIV+ SRO hotel residents (14 hotels) • Data • Self report (ACASI) vs. medical record extraction • HIV-related ambulatory care visits (0, 1, >2 visits) • Analysis • percent agreement & Kappa statistic

  6. Kappa = 0.12 (0.06-0.19) Cunningham. Med Care 2007

  7. Does outreach work to bring/keep HIV+ people in care?

  8. Few good studies of outreach • Definition of outreach is problematic • Outreach = letters, calls, face-to-face street contacts • Outreach workers = peers, RNs, MDs • Only 1 RCT of outreach • Most studies are observational – biases • Despite this, $24 million allocated to outreach via Ryan White CARE Act

  9. Outreach studies • RCT of RN outreach to women • Multi-site outreach study – marginalized HIV+ people in 10 sites • Medical Outreach to NYC SRO hotels • Outreach to youth • Outreach to IDUs with SEP • Outreach characteristics and kept appts

  10. RCT of RN outreach to women • RCT of RN outreach intervention vs. usual care • 75 women with HIV, mental illness, substance abuse with recent missed appt • Outreach intervention • Weekly visits with RN at pts’ home or outreach clinic • Activities • Made medical appts for pts • Linked pts to CM • Addressed insurance and transportation needs • Accompanied pts to appts • 1 year f/u, health care utilization = outcome Andersen. AIDS Patient Care STDS 2005

  11. Andersen. AIDS Patient Care STDS 2005

  12. Multi-site outreach study • Observational study that examined how outreach is assoc with retention in care • 773 HIV+ people from 7 sites in U.S. • Data = interviews, program logs, medical records (12-mo f/u) • Outreach • Appt reminder or reschedule • Service coordination • Relationship building / counseling • Provide concrete services (e.g. food, transportation) • Analysis • Outcome = time to 4-mo gap in care • Independent variable = # outreach contacts first 3 mos Cabral. AIDS Pt Care STDS 2007

  13. Cabral. AIDS Pt Care STDS 2007

  14. Medical outreach to SRO hotels • Observational pre-post study examining medical outcomes assoc with medical outreach • Targeted HIV+ residents of 8 NYC SRO hotels • Intervention - door-to-door in SRO hotels • Pre-intervention = CitiWide outreach team • Information about CitiWide services, supplies, syringe exchange, transportation • Intervention = CitiWide outreach team + MD • All the activities above • Med consultation, triage & evaluation, prescriptions, wound care, next-day appts • Data = interviews (pre/post, 8-18 mo lag) • Outcome = having a primary care provider

  15. Cunningham. J Health Care Poor Underserved 2005

  16. Outreach characteristics & kept appts • Observational study examining patient and program characteristics assoc with kept appts • 2781 medical appt records (2003-2005) • Patient and program characteristics • sociodemographic info • Appt type: same day/walk-in vs. future appt • Appt location: CitiWide vs. SRO hotel vs. CHCC • Person making appt: MD/NP vs. peer • Data = program logs, medical records • Analysis • Chi-square, regression analysis Cunningham. Am J Public Health 2007

  17. *p<0.05 Cunningham. Am J Public Health 2007

  18. Summary • SRO hotel residents • Self-report in care, but validity??? • Outreach studies • 1 RCT of RN outreach intervention • No difference in visits • Observational studies of outreach • >9 outreach contacts/3 mos -  gap in care • After medical outreach -  report primary care provider • Characteristics of outreach • Consider outreach by peer

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