3212014

1

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Todayrsquos Webinar

will be starting soon

For the audio portion of this meeting

Dial 1-888-394-8197

Enter participant code 733225

Patient Engagement

Strategies to keep patients at the center

of the HIV medical home

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Guidelines for Our Online Meeting Room

bull PLEASE TURN OFF YOUR COMPUTER SPEAKERS

bull Kindly mute your phone line

ndash Dial in 1-888-394-8197

ndash Enter participant code 733225

bull Questions amp Interactive activities

ndash Enter questions into the chat room

ndash Polls

bull Evaluation

3

3212014

2

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Todayrsquos Agenda

Patient Engagement amp the PCMH

Steve Bromer MD and Sarah Colvario HIV-MHRC Practice Facilitators

Project CONNECT ldquoCONNECTrdquoing Patients to Their Medical Home

D Scott Batey PhD LCSW PIP Program Manager

University of Alabama at Birmingham (UAB) 1917 Clinic

Peers for Self-management Support

Robert Kavanagh Case Manager

Face to Face Sonoma County AIDS Network

Improving Engagement to Support Quality

Adam Thompson Quality Management Consultant

4

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Learning goals

Participants will

bull Identify three strategies to support patient engagement in the

Patient Centered Medical Home (PCMH)

bull Explain the role of patient navigation in engagement in care

bull Identify benefits and barriers to using peers in patient navigation

bull Understand self-management activities as part of the spectrum

of patient engagement options

bull Understand the role peers can play in quality improvement

activities within your practice

bull Identify one next step for your practice in involving patients in

their care

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Patient Engagement amp

the Patient Centered Medical Home

Steve Bromer MD Director of Practice Facilitation

HIV Medical Homes Resource Center

Sarah Colvario MS Practice Coach

HIV Medical Homes Resource Center

3212014

3

bull ldquoConsumer engagement is the blockbuster drug of the centuryrdquo

ndash Dr Farzad Mostashari former National Coordinator for Health IT

Vital Signs HIV Prevention Through Care and Treatment -- United States MMWR December 2 201160(47)1618-1623

8

3212014

4

PCMH Framework

Building Blocks of High-Performing Primary Care Share-the-CareTM Model

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

5

The Facts

RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217

People who are actively engaged in their health care are

bull More likely to stay healthy and manage their conditions

bull Ask their doctors questions about their care

bull Following treatment plans

bull Exercise

bull Eat right

bull Receive health screenings and immunizations

Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf

What about for PLHIV

- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons

Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6

- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes

Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13

- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects

Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91

3212014

2

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Todayrsquos Agenda

Patient Engagement amp the PCMH

Steve Bromer MD and Sarah Colvario HIV-MHRC Practice Facilitators

Project CONNECT ldquoCONNECTrdquoing Patients to Their Medical Home

D Scott Batey PhD LCSW PIP Program Manager

University of Alabama at Birmingham (UAB) 1917 Clinic

Peers for Self-management Support

Robert Kavanagh Case Manager

Face to Face Sonoma County AIDS Network

Improving Engagement to Support Quality

Adam Thompson Quality Management Consultant

4

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Learning goals

Participants will

bull Identify three strategies to support patient engagement in the

Patient Centered Medical Home (PCMH)

bull Explain the role of patient navigation in engagement in care

bull Identify benefits and barriers to using peers in patient navigation

bull Understand self-management activities as part of the spectrum

of patient engagement options

bull Understand the role peers can play in quality improvement

activities within your practice

bull Identify one next step for your practice in involving patients in

their care

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Patient Engagement amp

the Patient Centered Medical Home

Steve Bromer MD Director of Practice Facilitation

HIV Medical Homes Resource Center

Sarah Colvario MS Practice Coach

HIV Medical Homes Resource Center

3212014

3

bull ldquoConsumer engagement is the blockbuster drug of the centuryrdquo

ndash Dr Farzad Mostashari former National Coordinator for Health IT

Vital Signs HIV Prevention Through Care and Treatment -- United States MMWR December 2 201160(47)1618-1623

8

3212014

4

PCMH Framework

Building Blocks of High-Performing Primary Care Share-the-CareTM Model

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

5

The Facts

RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217

People who are actively engaged in their health care are

bull More likely to stay healthy and manage their conditions

bull Ask their doctors questions about their care

bull Following treatment plans

bull Exercise

bull Eat right

bull Receive health screenings and immunizations

Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf

What about for PLHIV

- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons

Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6

- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes

Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13

- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects

Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91

3212014

3

bull ldquoConsumer engagement is the blockbuster drug of the centuryrdquo

ndash Dr Farzad Mostashari former National Coordinator for Health IT

Vital Signs HIV Prevention Through Care and Treatment -- United States MMWR December 2 201160(47)1618-1623

8

3212014

4

PCMH Framework

Building Blocks of High-Performing Primary Care Share-the-CareTM Model

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

5

The Facts

RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217

People who are actively engaged in their health care are

bull More likely to stay healthy and manage their conditions

bull Ask their doctors questions about their care

bull Following treatment plans

bull Exercise

bull Eat right

bull Receive health screenings and immunizations

Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf

What about for PLHIV

- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons

Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6

- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes

Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13

- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects

Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91

3212014

4

PCMH Framework

Building Blocks of High-Performing Primary Care Share-the-CareTM Model

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

5

The Facts

RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217

People who are actively engaged in their health care are

bull More likely to stay healthy and manage their conditions

bull Ask their doctors questions about their care

bull Following treatment plans

bull Exercise

bull Eat right

bull Receive health screenings and immunizations

Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf

What about for PLHIV

- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons

Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6

- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes

Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13

- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects

Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91

3212014

5

The Facts

RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217

People who are actively engaged in their health care are

bull More likely to stay healthy and manage their conditions

bull Ask their doctors questions about their care

bull Following treatment plans

bull Exercise

bull Eat right

bull Receive health screenings and immunizations

Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf

What about for PLHIV

- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons

Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6

- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes

Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13

- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects

Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91

3212014

6

Who promotes patient engagement in your clinic

bull Engagement should be promoted by all staff members - Primary care providers nurses medical assistantshellip

bull Significant evidence supporting use of lay health workers and

peer outreach workers - Improve ARV adherence - Reduce viral load - Quality comparable to masters-level staff

Roth AM Holmes AM Stump TE Aalsma MC Ackermann RT Carney TS Katz BP Kesterson J Erdman SM Balt CA Inui TS Can lay health workers promote better medical self-management by persons living with HIV An evaluation of the Positive Choices program Patient Educ Couns 2012 Oct89(1)184-90 Naar-King S Outlaw A Green-Jones M Wright K Parsons JT Motivational interviewing by peer outreach workers a pilot randomized clinical trial to retain adolescents and young adults in HIV care AIDS Care 2009 Jul21(7)868-73 Kenya S Jones J Arheart K Kobetz E Chida N Baer S Powell A Symes S Hunte T Monroe A Carrasquillo O Using community health workers to improve clinical outcomes among people living with HIV a randomized controlled trial AIDS Behav 2013 Nov17(9)2927-34

bull Evidence shows patient self-management improves linkage to and possibly retention in care

bull BUT interventions aimed at delivery service design are limited bull What is needed

bull More interventions to improve patient engagement in HIV care AND that well-designed trials of interventions in this area are studied in the future

Brennan A1 Browne JP Horgan M A systematic review of health service interventions to improve linkage with or retention in HIV care AIDS Care 2013 Dec 20

spectrumcenterumichedu

Project CONNECT

ldquoCONNECTrdquoing Patients to Their

Medical Home

D Scott Batey PhD MSW Research amp Informatics Services Center

Division of Infectious Diseases

University of Alabama at Birmingham

3212014

7

Objectives

To familiarize participants with a conceptual

framework to support patient engagement in

the Patient-Centered Medical Home (PCMH)

To explain the role of patient navigation

methods in engagement in care

To provide an overview of one supportive

strategy using peers as navigators

3212014

8

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

Linkage to Care UAB 1917 Clinic

Problem identified Scheduled new patient

appointments often not attended (ldquono showrdquo)

Study of patients calling to establish HIV care

at UAB 1917 Clinic 2004-2006

31 of patients (160 of 522) failed to attend a

clinic visit within 6 mos of initial call

Mugavero et al Clin Infect Dis 200745127-130

3212014

9

Characteristic

ldquoShowrdquo Group

(n=362)

ldquoNo Showrdquo Group

(n=160)

OR (95CI)

Age (years) 393 + 96 371 + 95 084 (068-104)

White male

Minority male

White female

Minority female

125 (345)

154 (425)

31 (86)

52 (144)

32 (200)

76 (475)

20 (125)

32 (200)

10 (Reference)

175 (105-291)

272 (130-568)

239 (127-452)

Private insurance

Public insurance

Uninsured

127 (351)

77 (213)

158 (436)

26 (162)

34 (213)

100 (625)

10 (Reference)

191 (103-354)

262 (156-439)

Days from call to

appointment

256 + 138 302 + 134 132 (114-153)

ldquoNo Showrdquo Phenomenon

Data presented as mean + SD or n (column )

Age OR per 10 years Days from call OR per 10 days

Mugavero et al Clin Infect Dis 200745127-130

Project CONNECT

Client-

Oriented

New Patient

Navigation to

Encourage

Connection to

Treatment

Emerge

Challenges New Identify a

Need

Make a plan

Name It

Empower

Others

Join You

to

Celebrate

Project CONNECT

Program launched January 1 2007

New patients have orientation visit within 5 days of their initial call to the clinic

Semi-structured interview psychosocial questionnaire amp baseline labs

Uninsured patients meet with clinic SW

Prophylactic antibiotics initiated more quickly

Expedited referral for SA MH services

3212014

10

Phase II The CONNECT Visit

Phase I

1 Scheduling within 5 days (plusmn12 days)

2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone

number h) Employer i) Current

HIV meds j) Baseline

income k) Date of

diagnosis 3 Rapport building 4 Reminder call day

before

Phase III

1 ldquoReferralrdquo 2 Rapport

building 3 Tour 4 Follow-up

through 5 Check Labs 6 Mtg at 1st

appointment 7 Reminder call 8 Data Entry

Record Keeping

Questionnaire

Interview (time startedended amp

interviewer)

Other

Standardize Measures Behavioral

bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers

Health Literacy Domestic Violence (clinic would need a protocol)

Circumstances Oriented

Needs

Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration

Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)

Medical Baseline

Adherence Medical knowledge drug history other meds CD4 VL disease history

Labs

Review amp follow-up as appropriate

Linkage

Introduction

CONNECT Program Evaluation

Pre-Post Study Design

Study Period Data from Pre-CONNECT era was collected between

August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)

Post-CONNECT data clients who called to make an

appointment between Jan1 ndash Dec 31 2007

Statistical Analyses

Multivariable logistic regression analysis

Wylie et al 4th International Conference on HIV Treatment Adherence 2009

CONNECT Program Evaluation Characteristic Pre-CONNECT

(n=522)

Post-CONNECT

(n=361)

Unadjusted

p-value

Age 387

97 396

103 018

White male

Minority male

White female

Minority female

157 (301)

230 (441)

51 (98)

84 (161)

131 (363)

149 (413)

28 (78)

53 (147)

025

Private Insurance

Public Insurance

Uninsured

153 (293)

111 (213)

258 (494)

105 (291)

121 (335)

135 (374)

lt001

Days from call to

appointment

270

138

256

101 008

Data presented as mean + SD or n (column )

3212014

11

CONNECT Program Evaluation

Time Period ldquoNo Showrdquo Unadjusted OR

(95CI)

Adjusted

OR (95CI)a

Pre-CONNECT (n=522)

Post-CONNECT (n=361)

307

177

10

048 (035-068)

10

054 (038-076)

a Multivariable model controls for age race sex insurance location of residence and

time from call to scheduled visit

0

5

10

15

20

25

30

35

40

45

Total

White M

ale

Minority M

ale

White Fem

ale

Minority Fem

ale

Private Insurance

Public Insurance

Uninsured

Sociodemographic Characteristics

N

o S

ho

w

Pre-CONNECT

Post-CONNECT

Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups

plt001 plt005

CONNECT Staff Survey

What was liked most about Project CONNECT ldquoImproved quality of carerdquo

ldquoPatients feel more welcome and at-easerdquo

ldquoA decreased no show raterdquo

What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and

ldquofeel overwhelmedrdquo

ldquoConcern over the increased patient load and the resulting

stress on the staffrdquo

ldquoNothing is wrongrdquo with the program

3212014

12

CONNECT Staff Survey

Other Feedback

Overwhelming support bull ldquoIncreased team-approach to carerdquo

bull ldquoI think it has been extremely successful and helpfulrdquo

bull ldquoThis is one of the most effective important new additions to the

1917 Clinic in a decaderdquo

Criticisms

bull ldquoNegative impact on staff time and increased staff exhaustionrdquo

bull ldquoI think project Connect is a great program that has had

successes in achieving quicker visits and improved adherence to

care but has opened many Pandorarsquos boxes regarding staff time

ptrsquos emotions and continued adherence to carerdquo

After CONNECT

What does the future hold

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

3212014

13

Jefferson County HIVAIDS

Community Coalition FAMILY CLINIC

ldquoCONNECTrdquoing Patients to

Their Medical Home Living Well

Living Well Overview

Purpose To assure HIV-infected persons are self-sufficient with their health

Start date ndash 613 21 participants enrolled

Peer Support Specialists

Project components

Extensive training amp refreshers

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

8

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

Linkage to Care UAB 1917 Clinic

Problem identified Scheduled new patient

appointments often not attended (ldquono showrdquo)

Study of patients calling to establish HIV care

at UAB 1917 Clinic 2004-2006

31 of patients (160 of 522) failed to attend a

clinic visit within 6 mos of initial call

Mugavero et al Clin Infect Dis 200745127-130

3212014

9

Characteristic

ldquoShowrdquo Group

(n=362)

ldquoNo Showrdquo Group

(n=160)

OR (95CI)

Age (years) 393 + 96 371 + 95 084 (068-104)

White male

Minority male

White female

Minority female

125 (345)

154 (425)

31 (86)

52 (144)

32 (200)

76 (475)

20 (125)

32 (200)

10 (Reference)

175 (105-291)

272 (130-568)

239 (127-452)

Private insurance

Public insurance

Uninsured

127 (351)

77 (213)

158 (436)

26 (162)

34 (213)

100 (625)

10 (Reference)

191 (103-354)

262 (156-439)

Days from call to

appointment

256 + 138 302 + 134 132 (114-153)

ldquoNo Showrdquo Phenomenon

Data presented as mean + SD or n (column )

Age OR per 10 years Days from call OR per 10 days

Mugavero et al Clin Infect Dis 200745127-130

Project CONNECT

Client-

Oriented

New Patient

Navigation to

Encourage

Connection to

Treatment

Emerge

Challenges New Identify a

Need

Make a plan

Name It

Empower

Others

Join You

to

Celebrate

Project CONNECT

Program launched January 1 2007

New patients have orientation visit within 5 days of their initial call to the clinic

Semi-structured interview psychosocial questionnaire amp baseline labs

Uninsured patients meet with clinic SW

Prophylactic antibiotics initiated more quickly

Expedited referral for SA MH services

3212014

10

Phase II The CONNECT Visit

Phase I

1 Scheduling within 5 days (plusmn12 days)

2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone

number h) Employer i) Current

HIV meds j) Baseline

income k) Date of

diagnosis 3 Rapport building 4 Reminder call day

before

Phase III

1 ldquoReferralrdquo 2 Rapport

building 3 Tour 4 Follow-up

through 5 Check Labs 6 Mtg at 1st

appointment 7 Reminder call 8 Data Entry

Record Keeping

Questionnaire

Interview (time startedended amp

interviewer)

Other

Standardize Measures Behavioral

bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers

Health Literacy Domestic Violence (clinic would need a protocol)

Circumstances Oriented

Needs

Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration

Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)

Medical Baseline

Adherence Medical knowledge drug history other meds CD4 VL disease history

Labs

Review amp follow-up as appropriate

Linkage

Introduction

CONNECT Program Evaluation

Pre-Post Study Design

Study Period Data from Pre-CONNECT era was collected between

August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)

Post-CONNECT data clients who called to make an

appointment between Jan1 ndash Dec 31 2007

Statistical Analyses

Multivariable logistic regression analysis

Wylie et al 4th International Conference on HIV Treatment Adherence 2009

CONNECT Program Evaluation Characteristic Pre-CONNECT

(n=522)

Post-CONNECT

(n=361)

Unadjusted

p-value

Age 387

97 396

103 018

White male

Minority male

White female

Minority female

157 (301)

230 (441)

51 (98)

84 (161)

131 (363)

149 (413)

28 (78)

53 (147)

025

Private Insurance

Public Insurance

Uninsured

153 (293)

111 (213)

258 (494)

105 (291)

121 (335)

135 (374)

lt001

Days from call to

appointment

270

138

256

101 008

Data presented as mean + SD or n (column )

3212014

11

CONNECT Program Evaluation

Time Period ldquoNo Showrdquo Unadjusted OR

(95CI)

Adjusted

OR (95CI)a

Pre-CONNECT (n=522)

Post-CONNECT (n=361)

307

177

10

048 (035-068)

10

054 (038-076)

a Multivariable model controls for age race sex insurance location of residence and

time from call to scheduled visit

0

5

10

15

20

25

30

35

40

45

Total

White M

ale

Minority M

ale

White Fem

ale

Minority Fem

ale

Private Insurance

Public Insurance

Uninsured

Sociodemographic Characteristics

N

o S

ho

w

Pre-CONNECT

Post-CONNECT

Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups

plt001 plt005

CONNECT Staff Survey

What was liked most about Project CONNECT ldquoImproved quality of carerdquo

ldquoPatients feel more welcome and at-easerdquo

ldquoA decreased no show raterdquo

What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and

ldquofeel overwhelmedrdquo

ldquoConcern over the increased patient load and the resulting

stress on the staffrdquo

ldquoNothing is wrongrdquo with the program

3212014

12

CONNECT Staff Survey

Other Feedback

Overwhelming support bull ldquoIncreased team-approach to carerdquo

bull ldquoI think it has been extremely successful and helpfulrdquo

bull ldquoThis is one of the most effective important new additions to the

1917 Clinic in a decaderdquo

Criticisms

bull ldquoNegative impact on staff time and increased staff exhaustionrdquo

bull ldquoI think project Connect is a great program that has had

successes in achieving quicker visits and improved adherence to

care but has opened many Pandorarsquos boxes regarding staff time

ptrsquos emotions and continued adherence to carerdquo

After CONNECT

What does the future hold

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

3212014

13

Jefferson County HIVAIDS

Community Coalition FAMILY CLINIC

ldquoCONNECTrdquoing Patients to

Their Medical Home Living Well

Living Well Overview

Purpose To assure HIV-infected persons are self-sufficient with their health

Start date ndash 613 21 participants enrolled

Peer Support Specialists

Project components

Extensive training amp refreshers

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

9

Characteristic

ldquoShowrdquo Group

(n=362)

ldquoNo Showrdquo Group

(n=160)

OR (95CI)

Age (years) 393 + 96 371 + 95 084 (068-104)

White male

Minority male

White female

Minority female

125 (345)

154 (425)

31 (86)

52 (144)

32 (200)

76 (475)

20 (125)

32 (200)

10 (Reference)

175 (105-291)

272 (130-568)

239 (127-452)

Private insurance

Public insurance

Uninsured

127 (351)

77 (213)

158 (436)

26 (162)

34 (213)

100 (625)

10 (Reference)

191 (103-354)

262 (156-439)

Days from call to

appointment

256 + 138 302 + 134 132 (114-153)

ldquoNo Showrdquo Phenomenon

Data presented as mean + SD or n (column )

Age OR per 10 years Days from call OR per 10 days

Mugavero et al Clin Infect Dis 200745127-130

Project CONNECT

Client-

Oriented

New Patient

Navigation to

Encourage

Connection to

Treatment

Emerge

Challenges New Identify a

Need

Make a plan

Name It

Empower

Others

Join You

to

Celebrate

Project CONNECT

Program launched January 1 2007

New patients have orientation visit within 5 days of their initial call to the clinic

Semi-structured interview psychosocial questionnaire amp baseline labs

Uninsured patients meet with clinic SW

Prophylactic antibiotics initiated more quickly

Expedited referral for SA MH services

3212014

10

Phase II The CONNECT Visit

Phase I

1 Scheduling within 5 days (plusmn12 days)

2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone

number h) Employer i) Current

HIV meds j) Baseline

income k) Date of

diagnosis 3 Rapport building 4 Reminder call day

before

Phase III

1 ldquoReferralrdquo 2 Rapport

building 3 Tour 4 Follow-up

through 5 Check Labs 6 Mtg at 1st

appointment 7 Reminder call 8 Data Entry

Record Keeping

Questionnaire

Interview (time startedended amp

interviewer)

Other

Standardize Measures Behavioral

bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers

Health Literacy Domestic Violence (clinic would need a protocol)

Circumstances Oriented

Needs

Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration

Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)

Medical Baseline

Adherence Medical knowledge drug history other meds CD4 VL disease history

Labs

Review amp follow-up as appropriate

Linkage

Introduction

CONNECT Program Evaluation

Pre-Post Study Design

Study Period Data from Pre-CONNECT era was collected between

August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)

Post-CONNECT data clients who called to make an

appointment between Jan1 ndash Dec 31 2007

Statistical Analyses

Multivariable logistic regression analysis

Wylie et al 4th International Conference on HIV Treatment Adherence 2009

CONNECT Program Evaluation Characteristic Pre-CONNECT

(n=522)

Post-CONNECT

(n=361)

Unadjusted

p-value

Age 387

97 396

103 018

White male

Minority male

White female

Minority female

157 (301)

230 (441)

51 (98)

84 (161)

131 (363)

149 (413)

28 (78)

53 (147)

025

Private Insurance

Public Insurance

Uninsured

153 (293)

111 (213)

258 (494)

105 (291)

121 (335)

135 (374)

lt001

Days from call to

appointment

270

138

256

101 008

Data presented as mean + SD or n (column )

3212014

11

CONNECT Program Evaluation

Time Period ldquoNo Showrdquo Unadjusted OR

(95CI)

Adjusted

OR (95CI)a

Pre-CONNECT (n=522)

Post-CONNECT (n=361)

307

177

10

048 (035-068)

10

054 (038-076)

a Multivariable model controls for age race sex insurance location of residence and

time from call to scheduled visit

0

5

10

15

20

25

30

35

40

45

Total

White M

ale

Minority M

ale

White Fem

ale

Minority Fem

ale

Private Insurance

Public Insurance

Uninsured

Sociodemographic Characteristics

N

o S

ho

w

Pre-CONNECT

Post-CONNECT

Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups

plt001 plt005

CONNECT Staff Survey

What was liked most about Project CONNECT ldquoImproved quality of carerdquo

ldquoPatients feel more welcome and at-easerdquo

ldquoA decreased no show raterdquo

What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and

ldquofeel overwhelmedrdquo

ldquoConcern over the increased patient load and the resulting

stress on the staffrdquo

ldquoNothing is wrongrdquo with the program

3212014

12

CONNECT Staff Survey

Other Feedback

Overwhelming support bull ldquoIncreased team-approach to carerdquo

bull ldquoI think it has been extremely successful and helpfulrdquo

bull ldquoThis is one of the most effective important new additions to the

1917 Clinic in a decaderdquo

Criticisms

bull ldquoNegative impact on staff time and increased staff exhaustionrdquo

bull ldquoI think project Connect is a great program that has had

successes in achieving quicker visits and improved adherence to

care but has opened many Pandorarsquos boxes regarding staff time

ptrsquos emotions and continued adherence to carerdquo

After CONNECT

What does the future hold

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

3212014

13

Jefferson County HIVAIDS

Community Coalition FAMILY CLINIC

ldquoCONNECTrdquoing Patients to

Their Medical Home Living Well

Living Well Overview

Purpose To assure HIV-infected persons are self-sufficient with their health

Start date ndash 613 21 participants enrolled

Peer Support Specialists

Project components

Extensive training amp refreshers

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

10

Phase II The CONNECT Visit

Phase I

1 Scheduling within 5 days (plusmn12 days)

2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone

number h) Employer i) Current

HIV meds j) Baseline

income k) Date of

diagnosis 3 Rapport building 4 Reminder call day

before

Phase III

1 ldquoReferralrdquo 2 Rapport

building 3 Tour 4 Follow-up

through 5 Check Labs 6 Mtg at 1st

appointment 7 Reminder call 8 Data Entry

Record Keeping

Questionnaire

Interview (time startedended amp

interviewer)

Other

Standardize Measures Behavioral

bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers

Health Literacy Domestic Violence (clinic would need a protocol)

Circumstances Oriented

Needs

Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration

Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)

Medical Baseline

Adherence Medical knowledge drug history other meds CD4 VL disease history

Labs

Review amp follow-up as appropriate

Linkage

Introduction

CONNECT Program Evaluation

Pre-Post Study Design

Study Period Data from Pre-CONNECT era was collected between

August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)

Post-CONNECT data clients who called to make an

appointment between Jan1 ndash Dec 31 2007

Statistical Analyses

Multivariable logistic regression analysis

Wylie et al 4th International Conference on HIV Treatment Adherence 2009

CONNECT Program Evaluation Characteristic Pre-CONNECT

(n=522)

Post-CONNECT

(n=361)

Unadjusted

p-value

Age 387

97 396

103 018

White male

Minority male

White female

Minority female

157 (301)

230 (441)

51 (98)

84 (161)

131 (363)

149 (413)

28 (78)

53 (147)

025

Private Insurance

Public Insurance

Uninsured

153 (293)

111 (213)

258 (494)

105 (291)

121 (335)

135 (374)

lt001

Days from call to

appointment

270

138

256

101 008

Data presented as mean + SD or n (column )

3212014

11

CONNECT Program Evaluation

Time Period ldquoNo Showrdquo Unadjusted OR

(95CI)

Adjusted

OR (95CI)a

Pre-CONNECT (n=522)

Post-CONNECT (n=361)

307

177

10

048 (035-068)

10

054 (038-076)

a Multivariable model controls for age race sex insurance location of residence and

time from call to scheduled visit

0

5

10

15

20

25

30

35

40

45

Total

White M

ale

Minority M

ale

White Fem

ale

Minority Fem

ale

Private Insurance

Public Insurance

Uninsured

Sociodemographic Characteristics

N

o S

ho

w

Pre-CONNECT

Post-CONNECT

Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups

plt001 plt005

CONNECT Staff Survey

What was liked most about Project CONNECT ldquoImproved quality of carerdquo

ldquoPatients feel more welcome and at-easerdquo

ldquoA decreased no show raterdquo

What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and

ldquofeel overwhelmedrdquo

ldquoConcern over the increased patient load and the resulting

stress on the staffrdquo

ldquoNothing is wrongrdquo with the program

3212014

12

CONNECT Staff Survey

Other Feedback

Overwhelming support bull ldquoIncreased team-approach to carerdquo

bull ldquoI think it has been extremely successful and helpfulrdquo

bull ldquoThis is one of the most effective important new additions to the

1917 Clinic in a decaderdquo

Criticisms

bull ldquoNegative impact on staff time and increased staff exhaustionrdquo

bull ldquoI think project Connect is a great program that has had

successes in achieving quicker visits and improved adherence to

care but has opened many Pandorarsquos boxes regarding staff time

ptrsquos emotions and continued adherence to carerdquo

After CONNECT

What does the future hold

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

3212014

13

Jefferson County HIVAIDS

Community Coalition FAMILY CLINIC

ldquoCONNECTrdquoing Patients to

Their Medical Home Living Well

Living Well Overview

Purpose To assure HIV-infected persons are self-sufficient with their health

Start date ndash 613 21 participants enrolled

Peer Support Specialists

Project components

Extensive training amp refreshers

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

11

CONNECT Program Evaluation

Time Period ldquoNo Showrdquo Unadjusted OR

(95CI)

Adjusted

OR (95CI)a

Pre-CONNECT (n=522)

Post-CONNECT (n=361)

307

177

10

048 (035-068)

10

054 (038-076)

a Multivariable model controls for age race sex insurance location of residence and

time from call to scheduled visit

0

5

10

15

20

25

30

35

40

45

Total

White M

ale

Minority M

ale

White Fem

ale

Minority Fem

ale

Private Insurance

Public Insurance

Uninsured

Sociodemographic Characteristics

N

o S

ho

w

Pre-CONNECT

Post-CONNECT

Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups

plt001 plt005

CONNECT Staff Survey

What was liked most about Project CONNECT ldquoImproved quality of carerdquo

ldquoPatients feel more welcome and at-easerdquo

ldquoA decreased no show raterdquo

What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and

ldquofeel overwhelmedrdquo

ldquoConcern over the increased patient load and the resulting

stress on the staffrdquo

ldquoNothing is wrongrdquo with the program

3212014

12

CONNECT Staff Survey

Other Feedback

Overwhelming support bull ldquoIncreased team-approach to carerdquo

bull ldquoI think it has been extremely successful and helpfulrdquo

bull ldquoThis is one of the most effective important new additions to the

1917 Clinic in a decaderdquo

Criticisms

bull ldquoNegative impact on staff time and increased staff exhaustionrdquo

bull ldquoI think project Connect is a great program that has had

successes in achieving quicker visits and improved adherence to

care but has opened many Pandorarsquos boxes regarding staff time

ptrsquos emotions and continued adherence to carerdquo

After CONNECT

What does the future hold

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

3212014

13

Jefferson County HIVAIDS

Community Coalition FAMILY CLINIC

ldquoCONNECTrdquoing Patients to

Their Medical Home Living Well

Living Well Overview

Purpose To assure HIV-infected persons are self-sufficient with their health

Start date ndash 613 21 participants enrolled

Peer Support Specialists

Project components

Extensive training amp refreshers

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

12

CONNECT Staff Survey

Other Feedback

Overwhelming support bull ldquoIncreased team-approach to carerdquo

bull ldquoI think it has been extremely successful and helpfulrdquo

bull ldquoThis is one of the most effective important new additions to the

1917 Clinic in a decaderdquo

Criticisms

bull ldquoNegative impact on staff time and increased staff exhaustionrdquo

bull ldquoI think project Connect is a great program that has had

successes in achieving quicker visits and improved adherence to

care but has opened many Pandorarsquos boxes regarding staff time

ptrsquos emotions and continued adherence to carerdquo

After CONNECT

What does the future hold

Blueprint for HIV Treatment Success

Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61

3212014

13

Jefferson County HIVAIDS

Community Coalition FAMILY CLINIC

ldquoCONNECTrdquoing Patients to

Their Medical Home Living Well

Living Well Overview

Purpose To assure HIV-infected persons are self-sufficient with their health

Start date ndash 613 21 participants enrolled

Peer Support Specialists

Project components

Extensive training amp refreshers

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

13

Jefferson County HIVAIDS

Community Coalition FAMILY CLINIC

ldquoCONNECTrdquoing Patients to

Their Medical Home Living Well

Living Well Overview

Purpose To assure HIV-infected persons are self-sufficient with their health

Start date ndash 613 21 participants enrolled

Peer Support Specialists

Project components

Extensive training amp refreshers

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

14

Living Well Lessons Learned

Peer involvement ldquois the bestrdquo

Peers need passion willingness to reach out

amp to increase their capabilitiesgrow

A structured program utilizing a holistic

approach to participants is helpful to peers

For research projects it is important to be

proactive with IRB aligning partners and

required peer trainings

Conclusions

Current healthcare landscape emphasizes

improved health outcomes

Project CONNECT is one strategy for

improving linkage to HIV primary medical

care

Community collaboration can provide

additional opportunities for synergy

Peer navigators may be an important future

strategy to improve linkage to care

Acknowledgments Ashley Bartee BSW

Kathy Gaddis MSW

Stephanie Gaskin MHA

Malcolm Marler DMin

Michael J Mugavero MD MHSc

James L Raper PhD CRNP JD FAANP FAAN FIDSA

Harriette Reed-Pickens

Sherron Wilkes MSW

Anne Zinski PhD

1917 Clinic Cohort University of Alabama at Birmingham (UAB)

Jefferson County HIVAIDS Community Coalition

Project CONNECT Team at the UAB 1917 Clinic

amp

All of the 1917 Clinic Patients who make my work so rewarding

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

15

Robert Kavanagh

Face To Face

Sonoma County

Using Peers for Self-Management

Support

Face to Face

Supportive Services

Case Management

Benefits Counseling

Support Groups

HIV Prevention Speakers Bureau

Outreach

Prevention with Positives

HIV Testing

Ending HIV in Sonoma County while supporting the health and

well-being of people living with HIVAIDS

Sonoma County CA USA

Face to

Face

SRCHC

SCHC

RRHC

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

16

The Shanti LIFE Program in Sonoma County

Health Centers have collaborated with CBO to run this Self-

Management Curriculum

19 cycles

Weekly meetings for 12 weeks each cycle

20-25 participants in each cycle

2-3 Facilitators

3-4 Peer Support Facilitators

Goals of LIFE Program Optimize health outcomes for people living with HIV

Reduce number of people who become infected with HIV

Align with National HIVAIDs Strategy

Clinical program evaluation of LIFE shows that participants

Reduce overall health problems (by 27-44) and overall personal

problems (by 38-50)

Decrease drugalcohol use and other health risking behaviors

Increase adherence to HIV treatment and other health routines

Increase the amount and quality of trusted support in their lives and

Improve coping with grief depression and Survival Stress

Shanti LIFE Program

LIFE stands for Learning Immune Function Enhancement

Course organized around ldquoco-factorsrdquo

A co-factor is a life issue that can impact health

LIFE participants explore their performance on 26

Cofactors and receive the knowledge motivation skills and

support necessary to set and reach goals related to their co-

factor performance and health

This program focuses on peer support and bonding and

emphasizes making contacts and lasting connections with

other HIV+ individuals

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

17

The Co-factors

Psychological

Belief about disease and health

Grief Depression and Loss

Sustained Survival Stress and Crisis Coping

Life Purpose and Goals

Co-factors (continued)

Social

Trusted support

Self-assertiveness

Patientprovider relationship

Altruism and Spirituality

Co-factors (Continued)

Biological

Health risking behaviors

Drugs and alcohol

Toxins and germs

Adherence

Body care

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

18

Each session includes

Presentation on one or more co-factor(s) in large group

Interactive exercise that helps in understanding co-factor

Small group discussion

Tool-box of ways to improve performance on the co-factor

Development of Health Action Plan

Check-in the following week on progress on Action Plan

Personal stories of how LIFE Program

has made an impact

IMPROVING ENGAGEMENT

TO SUPPORT QUALITY

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

19

Dimensions of Quality

How can we better engage patients to improve care

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

20

History of Involvement

bull Fingerprints ndash The Denver Principles Authors

and Souls

bull Blueprints ndash The Ryan White Program Drafters

and Supporters

bull Nuts and Bolts ndash Community Planning Members

bull Betterment ndash Quality Improvement Advocates

Methods of Involvement

bull Agitation

bull Activism

bull Advocacy

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

21

Strategies to Improve Engagement

bull Reorient Involvement for Quality

ndash Integrate patients into system design and

improvement teams

bull Encounter Improvement

ndash Use ldquotouch mappingrdquo to identify and improve

encounters

REORIENT INVOLVEMENT

FOR QUALITY

Strategy One

Collecting Patient Experience

Patient on QM Teams

Focus Groups

Surveys and Assessments

Patient Advisory Bodies

Patient ndash Provider

Solicitation Methods

ndash Patient Advisory Boards

ndash Needs Assessments

ndash Satisfaction Surveys

ndash Focus Groups

ndash Key Informant Interviews

ndash Patient-Provider

Conversations

ndash Patient Representation on

QM Teams

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

22

What am I trying to do

Structures

Patient Advisory Board

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

bull Expectations

ndash Provide Input and Feedback

ndash Share Personal Experience

bull Make-up

ndash Demographic Based

Quality Management Team

bull Qualifications

ndash Meeting Participation

ndash Person Living with HIV

ndash Knowledge and Skills of QM

bull Expectations ndash Provide Input and Feedback

ndash Support QI Activities

ndash Team Responsibilities

bull Make-Up

ndash Skills Based

Patient Advisory Boards

bull Members should

ndash represent the diversity of patients

ndash have a basic understanding of performance

measurement and HIV treatment

ndash understand basics of quality improvement

ndash review clinical quality data to provide feedback

for improvements

ndash generate ideas for improvement strategies

ndash support improvement processes

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

23

Identifying Quality Champions

bull Recruit from your ENTIRE patient population

bull Choose patients who

ndash Are self-managing patients

ndash Demonstrate prosocial behaviors

ndash Express a desire to learn new skills

ndash Are comfortable with and have access to technology

ndash Are able to commit to a defined period of involvement

ndash Can work collaboratively

bull The ldquosqueaky wheelrdquo might not be the best choice

Developing Experts

bull Recognition of patient experience as only a foundation

bull Capacity Building

ndash Advocacy Skills

ndash Performance Measurement

ndash Computational Skills

bull Statistical Calculations

bull Evaluating Data

ndash Quality Improvement amp Management Models

Next Steps hellip

bull Review current patient advisory structures ndash Purpose

ndash Policies and Procedures

ndash Recruitment

bull Identify opportunities for greater involvement ndash Reorient CABs towards quality

bull Identify patient quality champions

bull Develop patient quality experts

bull Integrate patient quality experts into QM Team

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

24

ENCOUNTER IMPROVEMENT

Strategy Two

Handoffs and Handshakes

Touch Points

bull The key moments or events that stand out for

those involved as crucial to their experience

of receiving or delivering a service

bull Touch points are the points of contact with a

service and intensely personal ldquoBig Momentsrdquo

on the journey where one recalls being

touched emotionally or cognitively that cause

deep and lasting memories

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

25

ldquoTouch Pointrdquo Map

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

Mapping lsquoTouch Pointsrsquo

Mapping touch points allows you to

ndash learn from consumer experiences with clinical

visits

ndash determine what is typical and exceptional

ndash probe explanations of experiences

ndash compare provider and users maps

ndash assist in linking care from lsquobeginning to endrsquo

Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66

A Walk Through My Clinic

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

26

Next Steps hellip

bull Engage clinical team in development of ldquotouch pointrdquo map

bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map

bull Disseminate blank ldquotouch pointrdquo map to patients

bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)

bull Review findings with patient advisory structures

Key Points

bull Engagement can be overwhelming if you donrsquot understand the community

bull Reorient involvement towards quality

ndash Leverage community strengths

ndash Identify patient quality champions and develop experts

bull Engage patients in quality activities such as ldquotouch pointrdquo mapping

Patient Engagement Spectrum

Patient Patient Patient Patient

Care Team

Care Team

Self-management Pt education Disease goals Health goals Action Plans Pt navigation

Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media

Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

27

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Please complete online Webinar Evaluation

httpswwwsurveymonkeycomsPatientEngagementNavigation

by Friday April 11 2014

79

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

80

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Resource Repository httpwwwcareacttargetorgmhrc

81

3212014

28

HIV-MHRC

Franccedilois-Xavier Bagnoud Center

Thank you

82