Measuring Our Collaborative Progress: Linkage and Retention in Upper Manhattan

Denis Nash, PhD, MPHDiane Addison, MIA, MPH

CUNY School of Public Health

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UMRG 3rd Learning Session: July 19th, 2012

Outline of presentation

• Overview of NY Links Collaborative Measures• Analysis of NY Links Collaborative data results

for the Upper Manhattan Regional Group• Using data to measure the effectiveness of

improvement strategies (examples from the field)

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NY Links Collaborative MeasuresPurpose of NY Links Collaborative Measures: For each team - to assess and support its internal linkage

and retention efforts and bench-mark its performance with providers in the region and

To measure the progress and impact of our collaborative efforts to improve linkage to and retention in HIV clinical care

• Frequency of reporting by sites: Every 2 months– Submission dates: April 2, June 1, August 1, October 1, etc…

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Upper Manhattan Regional Group (UMRG) site map and types of services provided

Site type N (%)

All UMRG participating sites 25 (100%)

HIV clinical care + HIV testing + supportive services 16 (64%)

HIV testing + supportive services 6 (24%)

HIV clinical care + supportive services (no testing) 1 (4%)

Supportive services only 2 (8%)

Data Source: Baseline site survey, updated: June 15, 2012 4

Map: Blue dots indicate clinical sites and yellow dots indicate supportive service and testing sites.

Measure Agency Type

Linkage All Programs that Conduct HIV Testing

Retention HIV Clinical CareNew Patient Retention

Clinical Engagement Supportive Services & General Medical AssistanceNew Client Clinical

Engagement

Brief Overview of NY Links Collaborative Measures

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% of UMRG sites reporting on collaborative measures

Data Source: NY Links collaborative measures—through June 2012 submission, updated: July 11, 2012

Measure # of sites that have submitted data

# of sites expected to submit data

% of sites reporting

April 2012 June 2012 April 2012 June 2012

Linkage 17 14 22 77.3% 63.6%

Retention 12 11 17 70.6% 64.7%

New patient retention

12 12 17 70.6% 70.6%

Clinical engagement

9 8 17 52.9% 47.1%

New client clinical engagement

11 10 17 64.7% 58.8%

Total number of participating UMRG sites: 25

Measuring Our Collaborative Progress

Data AnalysisQuestions to Keep In Mind

• What are our major findings . . .– What is the frequency of patients not getting

linked to and/or retained in care? Is this what you would expect?

– What is the impact of not being linked/retained in care?

– What is the feasibility that we can improve this?

UMRG: proportion of newly diagnosed clients linked to care within 30 days

Data Source: NY Links collaborative measures, updated: July 11, 2012 9

82 clients17/22 sites

95 clients14/22 sites

UMRG: proportion of patients retained in care

Data Source: NY Links collaborative measures, updated: July 11, 2012 10

6,633 patients12/17 sites

5,975 patients11/17 sites

UMRG: proportion of new patients retained in care

Data Source: NY Links collaborative measures, updated: July 11, 2012 11

872 patients12/17 sites

757 patients12/17 sites

UMRG: proportion of clients engaged in care

Data Source: NY Links collaborative measures, updated: July 11, 2012 12

815 clients9/17 sites

629 clients8/17 sites

UMRG: proportion of new clients engaged in care

Data Source: NY Links collaborative measures, updated: July 11, 2012 13

Engaged: number of new clients/patients in the reporting period, without a documented HIV clinical care provider or visit upon enrollment, who had at least one medical visit with a provider with prescribing privileges within 30 days of enrollment in the supportive service program

58 clients11/17 sites

64 patients10/17 sites

UMRG summary of collaborative measures: percentage linked, retained or engaged in care, data through June 2012

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% li

nked

, ret

aine

d, o

r eng

aged

Data Source: NY Links collaborative measures, updated: July 11, 2012

Measuring the effectiveness of interventionsExamples from the field

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Improving enrollment of HIV patients in care using continuous quality improvement, Uganda

16USAID Health Care improvement Project, “Improving coverage, retention and clinical outcomes of HIV patients in Uganda using continuous quality improvement”, February 2012.

Reducing missed appointments and number of lost clients through community tracking using peer clients and zoning to

ease follow-up: Pallisa District, Eastern Uganda

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Intervention

Intervention

USAID Health Care improvement Project: “Reducing missed appointments and number of lost clients through community tracking using PHAS and zoning to ease follow-up”, Rotich Leonard, 2012

Comparing outcomes for different linkage and retention strategies in HIV care, example

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**

**

* p<0.05; adjusted for facility type, urban/rural, year clinic began ART services, and patient loadM Lamb et al. PLoS One, 2012

Patient navigator intervention to increase screening colonoscopy, Lincoln Hospital

19Nash et al. J Urban Health, 2006

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Patient navigator intervention to increase screening colonoscopy, Lincoln Hospital

Nash et al. J Urban Health, 2006

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Patient navigator intervention to increase screening colonoscopy, Lincoln Hospital

Nash et al. J Urban Health, 2006

Next Steps• Share data with your team/agency:

- How does your linkage and retention performance compare with the collaborative?- How can/will your improvement efforts contribute the overall collaborative outcome?

• Intervention strategy Tracking Tool– Sign up for check in-call through doodle– Intervention Strategy Tracking Tool completed online

• Next submission due date: August 1, 2012

Thoughts/questions/comments on NY Links Evaluation?

• Denis Nash (dnash@hunter.cuny.edu)• Diane Addison (daddison@hunter.cuny.edu)

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