Liisa Randall, PhDDirector, Office of Health Care PlanningBureau of Infectious DiseaseMassachusetts Department of Public HealthJoan Pernice, RNC, MS, Clinical Health Affairs DirectorMassachusetts League of Community Health Centers

National HIV Prevention ConferenceDecember 7, 2015

ENHANCING PUBLIC HEALTH AND HEALTH CENTER COLLABORATION: TO IMPROVE THE HIV CARE CONTINUUM

Health Care System 2006 health care reform = 98% insured Infrastructure

Community health centers Primary health care Academic training and research extensive

MDPH-Funded HIV Prevention and Care Services Integrated = HIV, STI, HCV

36 funded providers 120 sites providing integrated testing ( 11 CBOs, 16 CHCs, 7 hospitals,

corrections); Targeted: prevalence, risk, SDH 36 agencies providing case management and support services (16 CBOs, 9 CHC,

11 other) Infrastructure

Community health centers (“RW clinics”) Flexible state funding Public health laboratory

CONTEXT OF HIV SERVICES: MASSACHUSETTS

HIV CARE CONTINUUM: MASSACHUSETTS

84% of those with 1 lab are virally suppressed

87% of those with 2 labs at least 3 mos apart are virally suppressed

“Engaged in care” = one laboratory test result (CD4 or viral load test) /yr“Retained in care” = 2 lab tests /yr; 3 mos apart“Viral suppression” = HIV viral load less than or equal to 200copies/mL.

61%

MASSACHUSETTS P4C: REDEFINING ROLES AND COLLABORATION

• Codman Square (Dorchester) • SSTAR (Fall River) • Lowell CHC • Mattapan CHC • North Shore CHC (Salem) • Whittier Street CHC (Roxbury)

• Training and Capacity Building• Learning Sessions• Webinars• Targeted training • Field services for partner notification/out-of-care re-engagement• Coordination with TAC; local training/TA providers (e.g. MDPH,

NEAETC)• Technical assistance and quality improvement support

• Individualized consultation and TA with practice coaches• CHC work plan development• Work flow planning • Policies and procedures • Identify and prioritize training and TA needs

• Data system and CQI report development (DRVS, ESPnet)

COLLABORATION TO SUPPORT IMPLEMENTATION AND PRACTICE

CHANGE

WORKFLOW PLANNING: PROCESS MAPPING

MONITORING IMPLEMENTATION

QI Coach CHC P4C SITE RATING Instructions: Please use the worksheet to rate each site on the categories (green, yellow, red) defined below. Please base your assessment on the previous month. Assessments are due on the 15th of each month. Rating Categories:

RED

This site has done some initial work, however barriers/issues are inhibiting progress or capacity to move forward. They need close monitoring to continue. In addition continuous coordination is required with MA DPH in order to align all T and TA

YELLOW

This site is actively engaged in planning and testing changes, working in teams and engaging in practice transformation activities to move forward with improved HIV integration, but progress or capacity to move forward is often or periodically hindered by current/specific situations. They require additional support and monitoring to assess and manage progress.

GREEN

This site has good capacity for doing the work of HIV integration practice transformation and the momentum to implement changes and keep this work a priority. They appreciate encouragement and occasional support, but their needs are minimal.

EVALUATION AND CQI: DRVS REPORTS

 

MAVEN: Surveillance and Management System

Modules:- Acute HCV surveillance- HIV- Sexually transmitted infections- Tuberculosis- HIV and STI case management and partner services- Other reportable infections -Foodborne illness- Refugee and immigrant health case mgt- HCV medical case mgt

ESPnet -Case reporting of notifiable diseases (HL7, LOINC, SNOMED)-Query clinical data from EHR “MDPH Net”-Aggregate reporting of screening and preventative services

-Query capability for CQI reports

State PH Lab

Hospitals & Other

Clinical Providers

Community Health

Centers

Centers for Disease Control

Reference and Clinical Labs

EHRs

Health Resources and Services Administration

EHRs

Mass League:

DRVS

EVALUATION AND CQI: PROJECT LEVEL

Routine testing Process mapping Learning sessions Targeted training and TA

HIV care integration Process mapping Learning sessions Targeted training and TA

Out-of-Care Re-engagement Protocol (line list, field services) Training Implementation conferences

STATUS: P4C IN MASSACHUSETTS

LESSONS LEARNED

Shift from dedicated service model Clarity in expectations (e.g. “routine” testing, “integrated” care) Attitudes and perception of staff (all levels) Aligning resources and historical investments

Implementing public health services Attitudes toward public health-delivered intervention

Providers Public health field staff

Understanding of public health roles and authorities Implement new protocols and practices

Collaboration essential to success Leverages experience and expertise Reinforces changing roles of public health and CHCs in service

delivery Allows and encourages application from/to other areas, services

Strategies for sustainability: Integrate communicable disease services into primary care

Balance primary and specialty care, relative to patient needs.

Return on investment: Integrate communicable disease services into primary care

Public health-delivered engagement support services

Improvement in population health

OPPORTUNITIES FOR LEARNING AND APPLICATION TO OTHER HEALTH AREAS