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CDPH Ryan White Part A Early Intervention Services (EIS)
Learning Collaborative Series Meeting #3
Thursday, November 17th, 2016
Agenda
• Welcome
• Learning Collaborative Process
• Quality Improvement Project Check-In
• EIS Final Presentation
• Agency EIS Program Presentations
o Howard Brown Health
o Lake County Health Department
• Data Visualization Presentation
• Coaching Team Meeting & Discussion
• Close
Goals for Today’s Meeting
1. Understand expectations and instructions for agency final QIP presentations on 1/25/17.
2. Obtain new ideas about EIS program best practices.
3. Leave with at least one new idea for creative data presentation.
PHIMC Mission and Vision
Public Health Institute of Metropolitan Chicago (PHIMC) enhances the capacity of public health and health care systems in Illinois to promote health equity and expand access to services.
How does PHIMC fit into Ryan White Part A?
• Technical assistance provider partnering with CDPH to implement Ryan White Quality Management (RW QM) across the Chicago EMA.
• Prior to March 2015, MATEC was lead on this project for 14 years.
• MATEC contracted primarily with Training Resources Network-Ms. Susan Thorner’s consulting agency.
The CDPH RWQM Program is….
A partnership between PHIMC and the Chicago Department of Public Health’s Quality Management (QM) Unit to provide training, technical assistance, and capacity building support to Ryan White Part A funded agencies in an effort to maintain sustainable internal QM infrastructure across the Chicago EMA.
How is RWQM Implemented?
• QM Site Visit Implementation
• Learning Collaboratives
• Webinars
• Support core MATEC Trainings
• Generating QM Newsletter/Online QM Resources
• Participation in Community Planning Efforts, i.e. CAHISC and the MAG
• Updating CDPH Standards of Care
• Audit Tool Creation & Data Collection
• Sub-recipient and CAHISC member surveys
• Conflict Resolution Training & Grievance Access
PHIMC and CDPH collaborate on the following items:
What is Quality Management (QM)vs.
Quality Assurance (QA) or Quality Improvement (QI)?
• Quality Management: All functions to evaluate and improve quality
i.e. QM committee + QM plan + QM site visits from funder, etc.
• Quality Assurance: Checking Boxesi.e. Program Monitoring Site Visits
• Quality Improvement: Enhancing Servicesi.e. Increasing percentage of AOMC clients receiving STI screening
2016 Early Intervention Services (EIS) Learning Collaborative Series: Structure
• Four provider meetings
• Best Practices Presentations from EIS Providers
• Quality Improvement Tips, Tricks, Trends
• Built in time to meet with coaches & team
Acknowledging the challenges with utilizing EIS in an LC format
• Brand new service category• Limited data • Standards of care do not include measurable indicators• Intervention contains non-clinical/social components
What We Know: The 4 Buckets of Early Intervention Services (EIS)
• HIV Counseling and Testing
• Linkage to Care
• Referrals
• Health Literacy
Applying the NHAS Indicators to EIS
NHAS Indicator 4: Increase percentage of newly diagnosed person
linked to HIV medical care within one month of their diagnosis to at
least 85%.
NHAS Indicator 5: Increase the percentage of person with diagnosed
HIV infection who are retained in HIV medical care to at least 90%.
NHAS Indicator 6: Increase the percentage of persons with diagnosed
HIV infection who are virally suppressed to at least 80%.
Steps to selecting an EIS Quality Improvement Project
Step 1: Select an NHAS indicator.
Step 2: Select one of the buckets of EIS.
Step 3: Identify small-scale projects.
Step 4: Conduct PDSA.
Step 5: Conduct full-scale QIP!
Quality Improvement Projects: Where You Should Be
Step 1: Select an NHAS indicator.
Step 2: Select one of the buckets of EIS.
Step 3: Identify small-scale projects.
Step 4: Conduct Plan, Do, Study, Act cycle(s), also known as PDSAs
Step 5: Complete full-scale QIP!
Agencies should be close to completion and have an idea of measurable progress made.
Quality Improvement Projects: Where You Should Be
Final Presentations: Lightning Rounds
• Coming up on Wednesday, January 25th 9:30 AM- 3:30 PM
• Breakfast and lunch will be provided
• Agencies will present in alphabetical order
• Presentation time slots will be strictly monitored
• Lightning Round Sessions!i. 1 or 2 slides that contain the most salient points of your projects
ii. Highlight data and rationale of project selection
iii. Simplicity and clarity are the idea!
[Insert Your Agency Name] EIS Quality Improvement Presentation:
[Insert topic, e.g. EIS Intake form]
• Include rationale for project selection
• Baseline data from your measures (including the dates)
• Include information on each improvement cycle (what was tried, what was the result per the data) – for early cycles, short measures of change are not necessary, but add value!
[Insert Your Agency Name] EIS Quality Improvement Presentation:
[Insert topic, e.g. EIS Intake form]
• What are your conclusions? Include significant challenges and how they were navigated
• Provide data to illustrate conclusions
• How are you sustaining improvement?
Presentation Sharing
• Online sharingi. Dropbox
ii. QM Hub (PHIMC website)
iii. Flash-drives
iv. Hard copies
More questions about the Process?
Ask your coach and your team!
EIS Program Presentations
Howard Brown Health, Eric Perry and Adrian Ellis • Federally Qualified Health Center
• Community-Based Org
• Centrally located in Lakeview, Rogers Park, and Englewood
Lake County Health Department, Valerie Johansen• Health Department
• Located in Waukegan, north of Chicago in Collar County
1. Discuss how to link newly or previously diagnosed individuals into HIV medical care.
2. Discuss how to complete a readiness assessment in preparation for starting treatment.
3. Summarize barriers and best practices to linking individuals into medical care.
LEARNING OBJECTIVES
MISSION
Howard Brown Health exists to eliminate the disparities in health care experienced by lesbian, gay, bisexual, and
transgender people through research, education, and the provision of services that promote health and wellness.
- August 2015 -
U.S. Department of Health and Human Services (DHHS) names HBH a Federally Qualified Health Center (FQHC).
Ambulatory Outpatient Medical Centers
HBH – Sheridan HBH – Clark
HBH – Halsted Broadway Youth Center
HBH – 55th Street HBH – 63rd Street
Eight Pillars of Health
Primary Care
Pediatrics
Youth Services
Social Services
Sexual and Reproductive
Health
Behavioral Health
Services
Elder Services
Research
SOCIAL SERVICES
Early Intervention Services/LTC
• Newly diagnosed (within 90 days) or Out of Care (over one year)
• Male-identified, 25 and older
• Up to six month program
Ryan White Part A
• Living with HIV
• Ongoing case management
Ryan White Part C
• Living with HIV
• 25 and older
• Up to one year program
Ryan White Part D
• Female-identified and/or younger than 25
• Ongoing case management or until age 25
EIS/LTC
• Assistance in coordinating ambulatory outpatient medical care (AOMC) for persons living with
HIV/AIDS, with a special emphasis on:
• Linkages to AOMC, for initiation of and ongoing HIV medical care
• HIV/AIDS and Medication Education and Counseling
• Access to Medication and Health Insurance
• Assistance with Medication and Appointment Adherence
• Access to Education Workshops and Ongoing Support Groups
• Referrals: Internal or external, per clients needs
EIS/LTC
Goals
Increase the number of persons living with
HIV/AIDS who engage into HIV Primary Care.
Increase the number of persons who gain access
to insurance.
Increase the number of persons that begin ART.
Increase the number of persons that reach and
maintain virologic suppression.
Increase the number of persons who remain
engaged in HIV Primary Care.
Learning Objective 1 | HOW TO LINK NEWLY OR PREVIOUSLY
DIAGNOSED PATIENTS INTO HIV CARE
LTC-1
•Days 1 - 30
LTC-2
•Days 31 - 60
LTC-3
•Days 61 - 90
Routine Care
• Days 91 -120
Discharge Planning
•Days 121 -150
Discharge from LTC
•Days 151 -180
Learning Objective 1 | Program Model
Referrals for Persons Living with HIV/AIDS
Internal
Primary Medical Care
Sexual and Reproductive Health Department
Behavioral Health Department
ExternalCommunity Organizations and Partners
Patient Referrals
Other Primary Care Providers
Learning Objective 1 | Linkage to Care
Referral to LTC
• PSS Introduces LTC staff at LTC-1
Partner Services Interview
• Elicitation of partners.
Partner Services
Schedules LTC-1
• PSS will complete apt reminder.
Partner Services
Team Notified
• Dedicated LTC Cell Phone
Newly Reactive HIV Test Result
• Less than 90 days
Learning Objective 1 | Linkage to CarePartner Services
National Standard of Care: Link HIV+ patients into medical care with 30 days.
HBH Standard of Care: Link HIV+ patients into medical care within 72 hours.
Eligibility Assessment
COMPLETED
APPOINTMENT REMINDER FOR LTC-1
Advise patient to remember to bring:
- List of Current Medications, if any- Proof of Identification: State ID, DL, Passport, Visa- Proof of Residency- Proof of Income- Proof of Insurance, if insured.
NOT COMPLETED
APPOINTMENT REMINDER FOR LTC-1
Eligibility assessment will be completed at 1st OV, provided pts’ willingness to complete.
Learning Objective 1 | Linkage to Care
Learning Objective 1 | LTC-1 or First Medical Appointment
Medical
Baseline HIV Labs
•CD4, Viral Load, Genotype•STI Screening
Physical Examination
Linkage to Care
HIV/MedicationHealth Literacy
Assist with ADAP and/or Insurance
Initiate Referrals, as needed
Schedule LTC-22nd Medical Visit
Learning Objective 2 |HOW TO COMPLETE A READINESS ASSESSMENT
IN PREPARATION FOR STARTING TREATMENT
LTC-2
Medical
Review of baseline labs
Discuss and/or Initiate
Treatment
Linkage to Care
Readiness Assessment
Adherence Counseling
Learning Objective 2 | Readiness Assessment
Readiness Assessment
Medication history
Treatment Naïve
Treatment Experienced
Medication Education
Barriers to Adherence
Learning Objective 2 | Readiness Assessment
Treatment Ready
YES
Initiation of Medication
NO
Establish Safety Plan
Learning Objective 2 | Readiness Assessment
Adherence Tools
Support Systems
Bi-monthly phone calls and
adherence reminders (LTC).
Pill Key Chains Weekly Pill Box
English
Spanish
Pill Bottles with Timer Caps
Phone Applications
Learning Objective 2 | Readiness Assessment
SUMMARY
Summary | Best Practices
1. A Client-centered approach
2. Education and Empowerment
3. Integration with medical care
4. Use of successfully vetted referrals
Summary| Challenges
1.Stigma
2.Lack of accurate HIV/AIDS Education
3.Financial resources and/or health
insurance
4.Housing
5.Substance abuse
DIRECT IMPACTS OF EIS/LTC
2015
Q&A
Prevention Services2016 Lake County Health Department and Community Health Center
Lake County Health Department & Community Health Center Early Intervention Services Program
Valerie Johansen, MPH
Ryan White Part A EIS Learning Collaborative
November 17, 2016
Prevention Services
Lake County Health Department & Community Health Center
703,462 residents in Lake County
Prevention Services
Lake County Health Department & Community Health CenterFederally Qualified Health Center & Local Health Department
- Provides comprehensive, coordinated, and continuous care for patients who receive primary care through the Community Health Centers – 7 Clinical Locations
- Mental Health and Substance Abuse services
- Responding to the functions of a local health department: assessment, assurance, and policy development
Two Governing Bodies- Community Health Center Governing Council- Board of Health
Prevention Services
LCHD/CHC Ryan White Services Overview
In 1990 a clinic for HIV/AIDS care known as the Medical Management Clinic or MMC was formed
Ryan White Services Today:
Part A: Ambulatory Care, Oral Health, Mental Health, EIS
Part B: Medical Case Management, Ambulatory Care
Additional Wraparound Services:
Health Education, Adherence Counseling, Outreach/Data to Care, Medical Benefits Navigation, Referral Services, Partner Services, PrEP/PEP Navigation
Prevention Services
LCHD/CHC Ryan White Services Overview
279 Unduplicated Patients Seen 3/1/2015-2/29/2016
Gender Reported
191 Men (68.5%)
85 Women (30%)
3 Transgender (1.0%)
Age Breakdown
0 <18 years old (0.0%)
11 19-24 year olds (3.9%)
107 25-39 year olds (38.3%)
132 40-59year olds (47.3%)
29 60-70+ year olds (10.4%)
Race/Ethnicity Reported
125 Black(44.8%)
150 Caucasian (53.8%)
4 Other (1.4%)
112 Reported Hispanic Ethnicity (40.1%)
Risk Reported
134 MSM (48.0%)
116 Heterosexual (41.6%)
19 IDU (6.8%)
8 MSM/IDU (2.8%)2 Perinatal (0.7%)
Prevention Services
STI Program
STI Program bridges the divide between Prevention and Care by conducting activities such as:
- Counseling and Testing for STI, HIV, and HCV- STI treatments- Surveillance for Chlamydia, Gonorrhea, Syphilis, HCV & HIV - Linkage to Care/Early Intervention Services - Outreach/Data to Care/Surveillance Based Services- PrEP/PEP Clinics & Navigation- Medical Benefits Coordination & Navigation- Medication Adherence and Risk Reduction Counseling in Ryan
White Ambulatory Clinic- QI for both Prevention and Care- Social Media Outreach/Marketing
Prevention Services
Lake County Health Department EIS Model
Utilizes Prevention experts in a Community Health Center setting to deliver the intervention
Cross-trained, Bilingual Staff- DIS Workers- EIS/Linkage Workers- DASA QHEIC Certified Counselors- IDPH Certified STI & HIV Counselors- Medication Adherence Counselors- Surveillance Staff- Medical Benefits Navigators- PrEP/PEP Navigators
Prevention Services
Lake County Health Department EIS Model
Our Philosophy:
Focusing on the individual in need rather than our roles, titles or job descriptions.
Prevention Services
Lake County Health Department EIS Model
100%
87.2%
72%69%
55%
% o
f P
eop
le
HIV Cascade*Bars are Percentages of Total # of People who are HIV+
HIV Care Continuum for Lake County 2015
HIV+ (a)
Diagnosed (b)
Linked to Care (c)
Prescribed ARTs (d)
Virally Suppressed (e)
972
848
Prevention Services
PATIENT IDENTIFIED
REFERRED TOCARE
ORIENTATION
PARTNERSERVICES
GIVEN TOSURVEILLENCE
SUPPORT
ASSESSMENT
REFERRALS
LINKAGECONFIRMED
REASSESS
LINK TOCARE
•Referral to Care – Immediately•Linkage to Care – < 90 Days•Confirmed in Care – 2 Appts•Referral to Other Services – As Needed•Released to Care – Successful Navigation
REVIEW OFGOALS
SUPPORT
RELEASED TOCARE
BUT WHAT NEXT? IS THIS ENOUGH?
Lake County Health Department EIS Model
Prevention Services
Prevention Services
Lake County Health Department EIS Model
Early Intervention Services Process
1. Assignment/Reassignment of Cases
2. Weekly “Cascade” Meetings
3. Case Discharged
Prevention Services
Cascade MeetingWho Is There
STI Program Staff
Ryan White Medical Case Managers
What Is DiscussedNew SBS casesEIS/Linkage ClientsNew Syphilis and/or HIV+ ClientsPartners of Syphilis and/or HIV+ IndividualsCase Management Clients PrEP ClientsClient Viral Load Suppression DataRetention Data
Prevention Services
Cascade Meeting
Assignment of new cases to staff
Review Current Caseloads
SBS
EIS/Linkage
PrEP
Review monthly viral load and gap in medical visit data
Reassignment of cases based on staff strengths and/or relationship with clients
Determine field visits – weekly
Prevention Services
Lake County Health Department EIS ModelStrategies for SuccessMedication Adherence Program
Structured assistance with pill box set-up and medication pick-up
tracking
“Cascade Report”Strong relationship between prevention, outreach/DIS, linkage and care
teams-all housed in one agency
Benefits NavigationMAP/PAP (ADAP) assistance, ACA enrollment, prior authorization assistance
Compassion and CareAttending appointment with client, assisting with transportation etc.
Prevention Services
Lake County Health Department EIS Model Best PracticesImplementation has demonstrated that patients are linked and engaged in medical care in a timely manner when enrolled in EIS services by:
- Fostering a strong relationship between prevention,
outreach/DIS, linkage and care teams-all housed in one
agency
- Allowing for a warm hand-off referral to on-site Medical Case
Management
Prevention Services
Lake County Health Department EIS Model Recommendations
Maximizing Limited Resources to Maximize Outcomes
- Stay client-centered: keep client needs first
- Partner with surveillance staff to introduce EIS workers to
private providers and hospitals
- Make Friends
- Integrate Surveillance and Data to Care as much as possible
- Integrated Data Collection System
Go Beyond Integrated Planning to Integrated Working
Prevention Services
Lake County Health Department EIS ModelRecommendations
Integrated Database
Prevention Services
Lake County Health Department EIS Model ChallengesWhat isn’t a Challenge?
- Stigma- Staff time/Capacity for new referrals- Funding- Transportation- Utilizing social media- Medical System Navigation- Unresponsive/Unreachable Patients- Being perceived as “Big Brother”- Balancing public health outcomes and patient health with
patient privacy and patient self determination
Prevention Services
Thank you!
Valerie Johansen, MPH Community Health Specialist
Lake County Health Department
STI Program
2400 Belvidere Rd
Room 1132
Waukegan, IL 60085
847.377.8450
3010 Grand Avenue Waukegan, Illinois 60085
847.377.8000 phone
http://www.health.lakecountyil.gov
2016 Lake County Health Department
Break
200 WEST JACKSON BLVD. | SUITE 2100 | CHICAGO IL 60606 | TEL 312 -922-2322 | FAX 312-922-2916 | AIDSCHICAGO.ORG
Data VisualizationSteps to making data into an engaging story
Alanna Berdanier
Quality Improvement vs. Quality Assurance
• Overall Goal: Present engaging data both externally and internally to demonstrate the work the we are doing at our respected agencies.
• Internally- we would like to be able to use data to motivate staff to participate in improvement projects
• Externally- we want to be able to use data to show-off the great work our agencies are doing at conferences, to funders, etc.
Quality Improvement vs. Quality Assurance
• Two terms to keep in mind when wondering how data visualization tools can be useful
• Quality Assurance = using data to identify performance gaps and specific issues with service delivery and documentation
• Quality Improvement = using data creatively to identify ways to make changes within the system itself to improve outcomes
Example of Performance Measure Data
Example of Performance Measure Data
Data Visualization Charts
More Data Visualization Tools
Data Visualization Tools: Real Time Data
Creating your own…
• Excel as a starting place for Data Visualization:
• Organize data for visualization:• Determine data elements
• Determine levels of aggregation
• Design Visualizations:• Identify audience
• Identify what message you want to communicate
• Appropriate graphics for data
Data Visualization Tool Uses
• Quality improvement and quality assurance projects
• Communicate to external sources the great work your agency is doing
• Conference Presentations
• Presentations to funders
• …the possibilities are truly endless
Questions
Questions or Comments?
Quality Improvement Team Discussion
• Answer final questions about QIP presentations
• Share ongoing QIP challenges and successes
• Give and receive support and feedback from colleagues
Meet with Your Coach & Team
Team 1: Charlotte Detournay/
Jenny Epstein
Austin CBC
Michael Reese
Regional Care Association
Lake County Health Department
Team 2: Silas Hyzer
Loyola Medical Center
Lurie Children’s Hospital
Mount SinaiUniversity of Illinois, Chicago
Team 5: Katie Morin
Access Community Health Network
Erie Family Health Center
Heartland Health Outreach
Howard Brown Health Center
Team 6: Barbara Schechtman
South Suburban HIV/AIDS Regional
Clinics
Provident Hospital
Core Center
University of Chicago
Team 3: Rod Kaup
AIDS Healthcare Foundation
Lawndale Christian Community
Health Center
Open Door Clinic
South Shore Hospital
Team 4: Laura Kuever
Re-assigned
Upcoming Learning Collaboratives
• Wednesday, January 25th, 9:30 AM- 3:30 PM
Other Upcoming CDPH QM activities
• QM Webinar 3 “QM for Non-clinical Services” by Barbara Schechtman coming up on Monday, December 5th at 12:00 pm
• Online QM Resource Hub: Update
• 2016 QM site visits are completed-Final Narrative Reports-Final Data Reports
Questions?
Thank You!
Ayla Karamustafa, Quality and Prevention Manager
Public Health Institute of Metropolitan Chicago
Gail Patton, Director of Quality Management
Chicago Department of Public Health
Adrian Ellis
Howard Brown Health
Eric Perry
Howard Brown Health
Valerie JohansenLake County Health [email protected]
Alanna Berdanier
AIDS Foundation of Chicago
