Materials, Publications, and Resources

Materials, Publications, and Resources

Advisory Committee Meetings

2018 Advisory Committee Meetings

March 15, 2018

Meeting Materials

Presentations

  • QAC/CAC Joint Meeting Report
    Anna Bezruki and Freda Coren │View Slides
  • VBP Arrangements and Quality Measurement
    Doug Fish, MD and Lindsay Cogan, PhD, MSView Slides
  • SUNY Downstate Medical Center Care Cascade 2016
    Jameela Yusuff, MD, MPH, FACPView Slides
  • Identifying Open and Active Patients using Azara Data
    Christine Kerr, MD, AAHIVS and Greg AugustineView Slides
  • Patient Reported Experience Measures (PREMs) 
    Freda CorenView Slides
  • PREMS: Utilizing CAHPS® Survey as part of Quality Management/Improvement 
    Andrew KienerView Slides
  • Quality of Care Program 2018 Quality Management Plan 
    Daniel Belanger View Slides
  • Quality of Care Program Mortality Review: March Update 
    Leah HollanderView Slides
  • Stigma Update 
    Kelly Hancock View Slides

2017 Advisory Committee Meetings

September 19, 2017

Meeting Materials

Presentations

  • Beyond Satisfaction: Integrating Patient-Reported Experience and Outcomes into Quality Measurement and Improvement
    Lisa Hirschhorn, MD, MPH | View Slides
  • Open and Active HIV Patients at Callen-Lorde: Engagement in Care
    Peter Meacher, MD | View Slides
  • New York Presbyterian’s HIV Care Cascade: Methodology & Next Steps
    Pete Gordon, MD, and Sam Merrick, MD | View Slides
  • Measuring and Addressing Stigma in Health Care Settings: Panel
    View Slides
  • Louisiana HIV Clinical Quality Group
    DeAnn Gruber, PhD, and Debbie Wendell, PhD, MPH | View Slides
  • New York State’s Health Care Transformation: The Path to Medicaid Payment Reform through Value-Based Payment Programs
    Douglas G. Fish, MD | View Slides
  • Quality of Care Program Mortality Review
    Leah Hollander | View Slides

June 15, 2017

Meeting Materials

Presentations

  • HIV Treatment Cascade Panel
    View Slides
  • HIV on Long Island: Heat Maps and REDCaps
    Joseph P. McGowan, MD, FACP, FIDSA | View Slides
  • New York State Ending the Epidemic Update
    Johanne Morne, MS | View Slides
  • AI Ending the Epidemic Metrics
    James M. Tesoriero, PhD | View Slides
  • Using Mortality (and Morbidity) Data to Drive Positive Changes
    Peter Meacher, MD | View Slides

March 16, 2017

Meeting Materials

Presentations

  • Mortality in HIV Infection: Monitoring Quality Outcomes
    Steven Johnson, MD | View Slides
  • Sentinel Events: AIDS Mortality: HIV-Related vs. Not HIV-Related Death as Categorized in HIV Surveillance
    View Slides
  • Expanded HIV Testing and Finding the Undiagnosed: Challenges, Insights, and Successes
    Uriel R. Felson, MD, MPH | View Slides
  • The High Priority Project: An EtE Pilot
    Bill LaRock, PhD; Jay Dobkin, MD; Eli Camhi | View Slides
  • Expanded HIV Mortality Surveillance
    Sandy Schwarcz | View Slides

2016 Advisory Committee Meetings

December 15, 2016

Meeting Materials

Presentations

  • 2016 NYS HIV Quality of Care Review: A New Way Forward in Four Parts
    Bruce Agins, MD, MPH | View Slides
  • Results of eHEPQUAL Pilot Test (4/1/2015-3/31/2016)
    View Slides
  • Assessing Clinic-Level Factors that Impact Viral Load Suppression
    Bisrat Abraham, MD, MPH; Carly Skinner, FNP-BC; Erica Crittendon, MS; Muhammad Daud, MD | View Slides
  • Engaging Primary Care Providers in Quality Improvement Strategies for Chlamydia Screening
    Gale Burstein, MD, MPH, FAAP; Susan Mancuso, FNP, MSN; Alison Muse, MPH; Gowri Nagendra, MPH; Amanda Cornett, MPH | View Slides
  • HIV Stigma in Healthcare Settings: Health Effects and Mechanisms of Intervention
    Whitney S. Rice | View Slides
  • Value-Based Care and the Role of Health Information Technology
    Andrew Hamilton, RN, BS, MS | View Slides
  • MetroPlus Partnership in Care: EtE Peer Care Connection Pilot
    Ross G. Hewitt, MD; Debra Williams, EdD | View Slides
  • Pharmacy Planning and Partnership Committee
    View Slides
  • Stigma Subcommitee
    Kelly Hancock; Barry Zingman | View Slides
  • HIV Tobacco Cessation Campaign Update
    View Slides

September 8, 2016

Meeting Materials

Presentations

  • Pharmacy Planning and Partnership Committee
    Maggie Brown | View Slides
  • Tobacco Cessation Improvement Campaign Update
    Kelly Hancock | View Slides
  • New York Presbyterian DSRIP and Practice Transformation Initiative
    New York-Presbyterian | View Slides
  • The Undetectables Viral Load Suppression (VLS) Project
    Vaty Poitevien, MD, Chief Medical Officer, Housing Works, Inc. | View Slides
  • Ending the Epidemic in NYS Together
    View Slides
  • Stigma Site Survey Update
    Kelly Hancock | View Slides
  • NYS eHEPQUAL Launch
    View Slides

 June 9, 2016

Meeting Materials

Presentations

  • The G.R.E.A.T. Study: Empowering People Living with HIV
    Kevin Fiscella and Michelle Boyd | View Slides
  • Transforming a Healthcare Organization Through Quality Improvement Projects
    Leonard Kabongo, MD, Msc GH, Gobabis District Hospital Namibia | View Slides
  • Health Information EcoSystem for HIV in Haiti: Using Data and Information Systems to fight against HIV in HAITI | View Slides
  • Survey Results: Prioritization of Key Populations for Targeted HIV-related Stigma Reduction Efforts | View Slides
  • 2016 HIV Medication Access Survey Results
    Dr. Rona Vail and Maggie Brown | View Slides
  • Update: HIV Tobacco Cessation Improvement Campaign
    Daniel Tietz and Dr. Kelly Ramsey | View Slides

March 10, 2016

Meeting Materials

Presentations

  • Update: Access to HIV Medications Subcommittee
    Dr. Rona Vail and Maggie Brown | View Slides
  • Evaluating the Effects of an Interdisciplinary Practice Model with Pharmacist Collaboration on HIV Patient Co-morbidities
    Rebecca Cope, Pharm.D., and Agnes Cha, Pharm.D., AAHIVP, BCACP | View Slides
  • Update: HIV Tobacco Cessation Improvement Campaign
    Emily Schlussel Markovic | View Slides
  • Azara Healthcare and eHIVQUAL
    Greg Augustine and Chris Wells | View Slides
  • An Electronic Web-based HCV Quality of Care Performance Measurement Program for NYC and NYS
    Jeremy Fagan, PhD | View Slides
  • Ending the Epidemic Medicaid Managed Care Pilot 
    Clinical Advisory Committee, March 10, 2016 | View Slides
  • healthfirst Ending the Epidemic Update | View Slides
  • Ending The Epidemic Comprehensive Viral Suppression & Care Connection Pilot Program
    Ross G. Hewitt, MD, and Debra Williams, EdD | View Slides
  • ETE MCO Pilot Data Reporting
    Amida Care | View Slides
  • VNSNY CHOICE SelectHealth High Priority Project | View Slides

2015 Advisory Committee Meetings

December 10, 2015

Meeting Materials 

Presentations

  • Joint Meeting Debrief: Quality of Care Clinical and Consumer Advisory Committee Meetings Dr. Bruce Agins and  Jacob Lowy | View Slides
  • Value Based Payment and HIV/AIDS | View Slides
  • Development of Quality Indicators for PrEP Services
    Toan Nguyen | View Slides
  • Update: HIV Tobacco Cessation Improvement Campaign
    Dr. Kelly Ramsey and Emily Schlussel Markovic | View Slides
  • Viral Load Suppression Lean Six Sigma Green Belt Project
    Shawntrell Miles | View Slides
  • Healthcare Stories Project (Activity #2) Applying Lean Thinking
    Rich Fowler and Mark Graupman | View Slides
  • NYCDOHMH Quality of Care Initiatives
    Bisrat K. Abraham, MD, MPH, and Sarah Braunstein, PhD, MPH | View Slides
  • Update: Access to HIV Medications Subcommittee
    Dr. Rona Vail and Maggie Brown | View Slides

September 8, 2015

Meeting Materials 

Presentations

  • Ending the Epidemic in New York State HIV
    Quality of Care Clinical and Consumer Advisory Committee Joint Meeting | View Slides
  • Ending the Epidemic: Making NYC the Epicenter of the End of AIDS
    Demetre C Daskalakis, MD, MPH | View Slides
  • Tracking and Disseminating Information on Progress Towards Ending the AIDS Epidemic in New York: A Dashboard System
    Denis Nash, PhD, MPH | View Slides

June 11, 2015

Meeting Materials 

Presentations

  • Ending the Epidemic in NYS: Blueprint to End AIDS | View Slides
  • NYLINKS Facility Level Cascade | View Slides
  • What Works for Reducing Stigma and Discrimination in Health Service: Lessons from a Decade of Global Efforts
    Laura Nyblade, PhD | View Slides
  • Discrimination Based on Disability Under the New York State Human Rights Law
    John P. Herrion | View Slides
  • Who Is Not Suppressed and What Are We Doing about It? NYS Quality of Care Program Low Performer Initiative and Quality Learning Networks
    Minna Yoshikawa and Stephanie Pottinger | View Slides
  • Access to HIV Medications Subcommittee & Pharmacy Partnership Work
    Mikaela Kislevitz | View Slides

March 12, 2015

Meeting Materials 

Presentations

  • HIV Care Cascade Panel | View Slides
  • Proposed Quality Incentive for HIV Special Needs Plans
    Franklin Laufer, PhD | View Slides
  • Amida Care Medicaid Quality Incentive Program
    Dr. Jerry Ernst and Dr. Oladipo Alao | View Slides
  • Results from 2013 eHIVQUAL Review Feedback Survey: User Ratings and Recommendations for Improvement
    Emily Knudsen-Strong, MSc | View Slides

2014 Advisory Committee Meetings

December 11, 2014

Meeting Materials

Presentations

  • HIV Readmissions New York State – 2012 Data
    Daniel Feller | View Slides
  • Healthcare Stories Project Strategies to Capture the Patient Experience
    Dan Tietz and Hazel Lever | View Slides
  • Patient and Family Engagement and Empowerment: a WHO Approach
    Nittita Prasopa-Plaizier, MPH, MSc | View Slides
  • Better health processes and outcomes in Low-Income Countries: How do we get there?
    A. Maina Boucar, MD, MPH | View Slides
  • Ending the Epidemic: Insights from the Epidemiology of HIV in New York State
    Lou Smith, MD, MPH | View Slides
  • Monitoring progress toward the end of the HIV epidemic in New York State: The view from NYC
    Sarah L. Braunstein, PhD, MPH | View Slides
  • Integrated Data Infrastructure for National HealthQual implementation
    Experience from Haiti Team | View Slides
  • Development of Quality Indicators for Hepatitis C Mono-Infection
    Minna Yoshikawa | View Slides

September 11, 2014

Meeting Materials

Presentations

  • Patient and Community Engagement: Dimensions of Quality
    Leonard Berry | View Slides
  • An Important Milestone in Ending the AIDS Epidemic | View Slides
  • The Future of the Ryan White Program: A Look into the Crystal Ball
    Michael Saag, MD | View Slides

June 12, 2014

Meeting Materials

Presentations

  • A systems approach to treating tobacco use and dependence
    Ann Wendland, MSL | View Slides
  • Suffolk County Health Services HIV Quality Improvement Project
    Shaheda Iftikhar, MD | View Slides
  • HEALTHQUAL Database
    Alvin Thalappillil | View Slides
  • Quality of Care Consumer Advisory Committee Meeting Summary
    Michelle Lopez | View Slides
  • HIV Readmissions New York State – 2012 Data
    Daniel Feller | View Slides
  • Readmissions Data Part 2
  • Readmissions Data Part 3
  • eHIVQUAL Reports
    Matthew Wetherll | View Slides
  • HIV Community Health Center (CHC) Focus Group: Key Findings
    Matthew Wetherell | View Slides

March 13, 2014

Meeting Materials

Presentations

  • HIV and Tobacco Use: Intersecting Epidemics
    Jonathan Shuter, M.D. | View Slides
  • Quality of Care Consumer Advisory Committee Meeting Summary for QAC
    Julian Brown | View Slides
  • Medication Error Reporting at Vista Family Health Center
    Kirsten B. Balano, PharmD | View Slides
  • NYS Quality of Care Program Viral Load Suppression Update
    Kristina Sandquist and Matthew Wetherell | View Slides
  • Hepatitis C: How Can We Focus on Quality of Care? | View Slides
  • The role of the Program Development and Quality Improvement Branch (PDQIB) in STD Prevention
    Jill Huppert, MD, MPH | View Slides
  • Working with FQHCs to Routinize HIV Testing Through EHR Changes
    Ben Tsoi, MD, MPH | View Slides
  • Readmissions Subcommittee Update
    Dr. Peter Gordon, Daniel Feller, and  Matthew Wetherell | View Slides

Drilling Down Data to Understand Barriers to Care

Looking Behind Numbers to Improve Care in Your Clinic

March 2015

Prioritization Strategies

Download PDF
Download PDF

To most effectively target your resources to those in need, consider prioritizing follow-up interventions by clinical information, patient characteristics, and service utilization. For example, you can assess by the following factors:

Viral load. Using the most recent viral load measurements on record, calculate the average viral load among all patients experiencing each barrier. The highest average viral loads can be used to help your facility identify the patients and barriers on which to focus. Keep in mind that one patient with an abnormally high viral load can skew the average. Be sure to closely examine the data to evaluate whether clinic-wide or individualized interventions will be most appropriate.

Key populations. Assessing problems by subpopulations (men who have sex with men (MSM), women, transgender populations, injection drug users, sex workers, those with unstable housing, prisoners, etc.) can help identify groups most in need of interventions and can help you design the most appropriate interventions for each population.

Those with frequent hospital and emergency department use. Identifying reasons why individuals frequently use hospital and emergency department resources in place of routine medical visits can help engage these patients in your clinic and ensure that resources are used efficiently.

Examples:

Prioritizing by Average Viral Load
Barrier No. of Patients Avg. Viral Load
(copies/mL)
Transportation 10 290 
Housing Instability 4 1,580
Insurance 1 74
Disclosure Issues 13 5,439
Refuses Treatment 1 30,982
Identifying Barriers to Retention Among MSM 
Barrier No. of Patients
Transportation 4
Housing Instability 6
Insurance 1
Disclosure Issues 11
Refuses Treatment 1

What is Drilling Down Data?

Drilling down data is a process of analyzing your patient care data in increasing detail to understand who is meeting performance measures and who is not. Through this process, key patient populations in need of attention and the barriers most relevant to these populations can be identified, which enables you to design population-specific and individual patient-specific interventions while efficiently targeting your resources.

By focusing on those patients most in need and tailoring follow-up activities to best meet those needs, your clinic will be more likely to achieve improvement and use resources wisely. Reaching out to patients in a way that meets their specific needs can foster ongoing relationships that improve overall engagement in care.

Four Main Steps to Drilling Down Data

  1. Develop a list of patients who do not meet the defined criteria of your measure.
  2. Identify reasons each patient does not meet the criteria.
  3. Tally the reasons.
  4. Develop targeted plans to address the most common or relevant issues.

Why Drill Down Data?

Data can reveal important information about barriers to care experienced by your patient population. With simple analysis of your data, you can identify areas for improvement and develop targeted plans to address those areas. In the following panels, a step-by-step method of drilling down your data is presented. This process can be used for any measure of patient care, but retention is the example used throughout this brochure.

Engaging your multidisciplinary team to regularly collect and drill down data is the most effective way to elucidate the reasons why standards are not met in specified populations and to develop follow-up plans. This team may include physicians, case managers, nurses, social workers, pharmacists, peer navigators, the data team, or any other clinic staff involved in providing care for the patient. Regular (e.g., weekly, monthly, or quarterly) team meetings for case review should occur to maintain involvement of all team members, share information and patient status updates, and identify areas for improvement.

Four Steps to Drilling Down Data

Example: Assessing Patient Retention

Download PDF
Download PDF

Helpful Tips and Resources

Tips

Designate a person or team to manage the drill down process and ensure that it is repeated at regular time intervals.

Set a regular process for discussing and presenting data to staff and at regular committee meetings.

Involve peers in discussions, especially concerning strategies to address stigma.

If using an electronic system, create a routine report template of patients who do not meet the standard measured by the indicator. Set it to run at regular intervals; for example, immediately after the end of the month.

For follow-up with patients:

  • Establish a protocol for contacting patients; i.e., determine the most effective methods of contact.
  • Establish a time frame for follow-up as well as a minimum and maximum number of attempts for follow-up.
  • Document contact and follow-up attempts, dates, and results.
  • Determine a policy for patients who are not successfully contacted within the follow-up time frame

Resources

Further reading: NYSDOH AIDS Institute brochure: Do You Know Where Your Patients Are? Using an Active Patient List to Monitor Patient Retention in HIV Care and Improve Health Outcomes

Case study: Utah State University: Drilling Down to Understand Outcome

Resources for Locating Patients:

 

Healthcare Stories Project

Welcome

healthcare-stories-project

Welcome to the Healthcare Stories Project, a series of healthcare improvement strategies that capture and learn from health user experiences.

The Healthcare Stories Project offers healthcare programs tools to capture how healthcare users experience their healthcare services. This three-activity campaign also aims to strengthen user participation in processes of care, and in doing so, improve the quality of care provided.

This quality of care campaign kicked off in Spring 2014 and is ongoing throughout New York State. This project consists of three activities, each with a poster and instructional guide (see below). 

Implement any of the activities that may be useful for your agency. They do not have to be done in order to be effective tools—each one captures patient experience from a different angle.

To join the Healthcare Stories Project, sign up here for the Program Management Tool, an interactive platform that connects a community of healthcare agencies, provides materials, and keeps up to date on the latest news about the project.

Participating agencies say that the Healthcare Stories Project:

  • Offers a creative, fun project that motivates staff.
  • Engages healthcare users in QI.
  • Generates helpful, clinic-specific information.
  • Provides organizational benefits beyond an HIV program.

For more information or to receive assistance, please contact:

Daniel Tietz
AIDS Program Manager for Consumer Affairs
New York State Department of Health AIDS Institute
Albany, New York
Phone: 1-518-473-7542
Fax: 1-518-486-1315
E-mail: daniel.tietz@health.ny.gov

 

Activity 1: Word Cloud

healthcare-stories-project

What Words Would You Use? 

Patients share the words and stories they associate with ‘quality of care’. The words are visually displayed to create a word cloud to be shared and discussed with everyone in the clinic.

Materials:

Activity 2: Healthcare User Visit Experience Map

healthcare-stories-project

How’s Your Visit Going?

Fall 2014

Patients identify the ‘touch points’, or emotionally significant moments, along their visit to allow providers to pin point exactly in the service delivery process users react and why.

Materials:

Activity 3: The Co-Production of Quality

healthcare-stories-project

 

Patients and providers examine how each play a role in the production of service delivery and quality of care at their clinic.

Do You Know Where Your Patients Are?

Using an Active Patient List

Monitor Patient Retention In HIV Care And Improve Health Outcomes

The NYSDOH AIDS Institute’s ‘Do You Know Where Your Patients Are’ brochure presents information and tips help care providers address retention issues at their facility.

Benefits of Focusing on Patient Retention

Patient engagement in care is directly correlated with positive health outcomes. For people living with HIV/AIDS, regular medical visits facilitate treatment adherence and clinical monitoring, which consequently lead to improved viral load suppression, reduced occurrence of opportunistic infection, decreased odds of antiretroviral drug resistance, and reductions in mortality [1-4]. Patients who are engaged in regular medical care and become virologically suppressed are also less likely to transmit the virus to others, establishing retention as a key strategy for HIV prevention. Furthermore, patients with regular clinic visits are more likely to receive comprehensive care, including preventive care, reducing the frequency of hospitalizations and emergency department visits, and decreasing overall healthcare expenditures.

Monitoring Patient Retention

A key tool for monitoring patient retention is an active patient list: a record of every patient who visited your clinic for medical services within a given time period, often the previous 12 months. An up-to-date list provides the necessary information to:

  • Identify patients who have fallen out of care
  • Monitor patient attendance over time
  • Track individual patient attendance patterns
  • Measure the rate of patient retention at your clinic
  • Observe trends in patient retention and demographics

Frequently updating the active patient list allows you to dynamically monitor patient retention in your clinic for different time intervals, varying in duration and starting point. This flexibility allows you to focus on different aspects of patient retention and levels of patient engagement at your clinic. For example, your clinic may choose to update its active patient list quarterly, reviewing patient retention for a shifting 12-month interval each quarter, rather than just within a calendar year. In this case, patients that should be seen bimonthly but have become lost to follow-up, for example, would be identified sooner.

Ultimately, your clinic will be able to monitor the retention of a previously identified cohort of active patients longitudinally (e.g., 1 clinical visit in each 6-month interval of a 24-month period, or longer). This will allow you to monitor the same patients over an extended period of time to track retention more meaningfully and correlate retention with long-term health outcomes.

Helpful Tips:

  • Designate a person in your clinic to manage the patient list.
  • Orient staff to the importance of retention in care.
  • Systematize the process of regularly identifying patients lost to follow-up in the patient list.
  • Develop a routine method for updating your active patient list. Include such items as established update schedule, staff responsibility, data validation, and security.
  • Identify and access all data sources to obtain the information needed for your active patient list.
  • Regularly verify accuracy of your active patient list. Check for red flags. Are there obvious errors or omissions?
  • Implement a policy for designating patients as inactive. Decide whether a certain number of unsuccessful intervention attempts is sufficient to consider follow-up patients inactive.
  • Consider monitoring missed patient visits, which can provide additional information regarding patient retention at your clinic.
  • Incorporate enough elements to uniquely identify patients in your list. Include all dates of clinical visits in chronological order. In addition to this basic information, consider including elements such as contact, clinical, or other demographic information
Example Active Patient List
First Name Last Name Middle Initial Gender DOB Clinical Visit Date 1 Clinical Visit Date 2
John Doe B. Male 7/11/1977 9/23/11 2/12/12

Strategies for locating patients: If contacting a patient directly is unsuccessful, other resources for locating patients may include:

  • Internal: Registries for within-clinic services (e.g., mental health), electronic medical records (EMR) for hospitalization or death.
  • External: Other local clinics and support service providers, Social Security Death Index, state or local incarceration directory, local health department, case managers, pharmacies.
Intervention Examples
Telephone calls to patients as well as their friends and family, SMS (text) message appointment reminders, open access scheduling, counseling, mental health support, substance abuse treatment, transportation services, case management, peer and near-peer coaches or navigators, preemptive interventions for patients at high-risk for non-retention, secure message line for appointment requests (after-hours calls), collect/verify contact information regularly (telephone numbers, email, etc.).
References
  1. Berg MB, Safren SA, Mimiaga MJ, et al. Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic. AIDS Care 2005;17(7):902-907.
  2. Giordano TP, Gifford AL, White AC Jr, et al. Retention in care: A challenge to survival with HIV infection. Clin Infect Dis 2007;44(11):1493–1499.
  3. Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis 2009;48(2):248-256.
  4. Tripathi A, Youmans E, Gibson JJ, et al. The impact of retention in early HIV medical care on viro-immunological parameters and survival: A statewide study. AIDS Res Hum Retroviruses 2011;27(7):751-758.

Four Steps in Creating and Maintaining Your Active Patient List

Four Steps in Creating and Maintaining Your Active Patient List
Download PDF

Selected Bibliography

Reviews

  • Gardner EM, McLees MP, Steiner JF, et al. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011;52(6):793-800.
  • Geng, EH, Nash, D, Kambugu, A, et al. Retention in care among HIV-infected patients in resource-limited settings: Emerging insights and new directions. Curr HIV/AIDS Rep 2010;7:234-244.
  • Horstmann E, Brown J, Islam F, et al. Retaining HIV-infected patients in care: Where are we? Where do we go from here? Clin Infect Dis 2010;50:752-761.
  • Mugavero MJ, Norton WE, Saag MS. Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care delivery system. Clin Infect Dis 2011;52(suppl 2):S238-S246.
  • Mayer KH. Linkage, engagement, and retention in HIV care: essential for optimal individual- and community-level outcomes in the era of highly active antiretroviral therapy. Clin Infect Dis 2011;52(suppl 2):S205-S207.

Outcomes/Risk Factors

  • Berg MB, Safren SA, Mimiaga M J, et al. Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic. AIDS Care 2005;17(7):902-907.
  • Giordano TP, Gifford AL, White AC Jr, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis 2007;44(11):1493–1499.
  • Giordano TP, Hartman C, Gifford AL, et al. Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials 2009;10(5):299-305.
  • Moore RD, Bartlett JG. Dramatic decline in the HIV-1 RNA level over calendar time in a large urban HIV practice. Clin Infect Dis 2011;53(6):600-604.
  • Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis 2009;48(2):248-256.
  • Mugavero MJ, Amico KR, Westfall, AO, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr 2012;59(1):86-93.
  • Mugavero MJ, Napravnik S, Cole SR, et al. Viremia copy-years predicts mortality among treatment-naive HIV-infected patients initiating antiretroviral therapy. Clin Infect Dis 2011;53(9):927-935.
  • Tripathi A, Youmans E, Gibson JJ, et al. The impact of retention in early HIV medical care on viro-immunological parameters and survival: A statewide study. AIDS Res Hum Retroviruses 2011;27(7):751-758.

Measurement

  • Dombrowski JC, Kent JB, Buskin SE, et al. Population-based metrics for the timing of HIV diagnosis, engagement in HIV care, and virologic suppression. AIDS 2012;26(1):77-86.
  • Mugavero MJ, Davila JA, Nevin CR, et al. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS 2010;24(10):607-613. Interventions
  • Aziz M, Smith KY. Challenges and successes in linking HIV-infected women to care in the United States. Clin Infect Dis 2011;52(suppl 2):S231-S237.
  • Cabral HJ, Tobias C, Rajabiun S, et al. Outreach program contacts: do they increase the likelihood of engagement and retention in HIV primary care for hard-to-reach patients? AIDS Patient Care STDS 2007;21(suppl 1):S59–S67.
  • Bradford J, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS 2007;21(suppl 1):S49-S58.
  • Zaller ND, Fu JJ, Nunn A, et al. Linkage to care for HIV-infected heterosexual men in the United States. Clin Infect Dis 2011;52 (suppl 2):S223-S230.

 

Selected Resources

New York State Department of Health Quality of Care Programs

“The AIDS Institute is committed to promoting, monitoring, and supporting the quality of HIV clinical services for people with HIV in New York State. The Office of the Medical Director coordinates quality improvement activities including the development of clinical performance measures derived from practice guidelines, on-site quality of care reviews, as well as the promotion of quality improvement activities, peer learning opportunities for HIV providers, and consultations to support on-site quality improvement efforts. The ultimate objective for each HIV program in New York State remains the development of a sustainable independent quality management program that reflects the capacity to dynamically analyze and continuously improve HIV treatment, care, and supportive services.

The Office of the Medical Director coordinates the participation of several groups of stakeholders to accomplish these tasks including:  (1) an internal Quality of Care Workgroup based at the AIDS Institute, responsible for implementation and refinement of the program within the New York State Department of Health AIDS Institute; (2) the AIDS Institute’s Medical Care Criteria Committee chaired by Dr. Judith Aberg, responsible for clinical guidelines development; (3) the HIV Quality of Care Clinical Advisory Committee chaired by Dr. Peter Gordon, comprised of expert HIV providers who advise on the development, implementation, and refinement of the Quality of Care Program; (4) the New York City Part A Quality Management Program Advisory Committee; and (5) the AIDS Institute’s Consumer HIV Quality Committees. The AIDS Institute solicits feedback through these committees in planning, implementing, and evaluating quality of care program activities.  The interaction of providers and consumers with the AIDS Institute through these various groups allows New York State to remain responsive to the needs of the communities that it serves, while responding to changes in clinical and scientific knowledge.” 
⇒ Learn more

eHIVQUAL 

eHIVQUAL is an online HIV performance measurement tool for HIV providers that allows them enter data on their patients on a variety of quality  indicators and track performance results in order to identify areas for improvement.  eHIVQUAL provides users with a number of reports to highlight and diagnose their data. 
⇒ Learn more

Health Data NY

As part of New York State’s commitment to transparency of data, the finalized eHIVQUAL performance data report from HIV ambulatory care programs is available online. 
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NY Links

“NY Links focuses on improving linkage to care and retention in care and supports the delivery of routine, timely, and effective care for Persons living with HIV/AIDS (PLWHA) in New York State. We also bridge systemic gaps between HIV related services in order to achieve better outcomes for PLWHA through improving systems for monitoring, recording, and accessing information about HIV care in NYS. We use a regional approach, utilizing the learning collaborative model, to fortify the links holding together communities of practice, and the links grounding them in the communities of consumers they serve. New York Links was created through a HRSA HIV/AIDS Bureau (HAB)-sponsored Special Projects of National Significance (SPNS).  Since September of 2015 it is under the Governor’s Ending the Epidemic Initiative through the NYSDOH AIDS Institute.”
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National Quality Center

“The aim of this initiative is to build the capacity to improve the quality of HIV/AIDS care and services across the United States and its territories. NQC provides support and assistance that enable grantees to respond to and to implement quality management legislative mandates. Think of the National Quality Center as a personal quality improvement expert, a hands-on assistant that will help advance quality management programs, provide access to a central repository of key quality improvement resources, and help connect HIV providers across the country. NQC can give the support needed to improve the care and services provided to individuals with HIV/AIDS.”
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HealthQual International 

“HEALTHQUAL International is a capacity building initiative to facilitate sustainable national and clinic-based quality management programs with the goal of enhanced patient outcomes and improved population health in low- and middle-income countries. The HEALTHQUAL framework consists of three main elements: Performance measurement, quality improvement, quality management program. HEALTHQUAL offers a unique public health, peer-to-peer government-led approach to quality management (QM). Our experienced staff focuses technical assistance and support through partnerships with Ministries of Health to implement and reinforce health care systems to build sustainable national QM programs.”
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