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Quality of Care Programs

HIV Quality of Care Program

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

The Office of the Medical Director coordinates the participation of several groups of stakeholders to accomplish these tasks including:  (1) an internal Quality of Care Workgroup based at the AIDS Institute, responsible for implementation and refinement of the program within the New York State Department of Health AIDS Institute; (2) the AIDS Institute's Medical Care Criteria Committee, responsible for clinical guidelines development; (3) the HIV Quality of Care Clinical Advisory Committee, comprised of expert HIV providers who advise on the development, implementation, and refinement of the Quality of Care Program; (4) the Quality Committee for HIV Medicaid Managed Care Special Needs Plans (HIV SNPs); (5) the New York City Part A Quality Management Program Advisory Committee; and (6) the AIDS Institute's Consumer HIV Quality Committees. The AIDS Institute solicits feedback through these committees in planning, implementing, and evaluating quality of care program activities.  The interaction of providers and consumers with the AIDS Institute through these various groups allows New York State to remain responsive to the needs of the communities that it serves, while responding to changes in clinical and scientific knowledge.

Statewide quality of care program standards that apply to all HIV health care facilities, regardless of their caseload, location or service delivery model have been developed, reviewed annually, and revised as needed.  These standards ensure that the best clinical care is provided to patients throughout New York State by improving systems of care delivery and by stimulating quality monitoring.  In addition to medical chart reviews, organizational assessment tools have been created to determine the extent to which these program standards have been implemented.  Annual assessments of providers’ quality management programs are conducted by AIDS Institute staff and consultants.  Data from these assessments are used to guide technical assistance and consultation to further enhance providers’ quality management programs and to develop future strategies to advance the statewide Quality of Care Program.  Statewide and regional organizational assessment reports are developed and reviewed annually to assess areas of common need.  Workshops, webinars and other opportunities for capacity building and peer learning are developed based on these findings.

All HIV programs throughout New York State were expected to self-report their quality of care performance data.  In 2009, 200 HIV programs submitted their performance data based on a review of 10,361 medical records. For the first time, the HIVQUAL review was completed online using the eHIVQUAL application.  HIV programs were able to submit their completed reviews online and to immediately access performance data results, allowing them to immediately utilize their data findings to prioritize upcoming quality activities.  Data findings were presented to various provider stakeholders and consumer representatives.  For the first time, a statewide HIVQUAL quality review of programs providing adolescent HIV primary care in 2010 was performed.  Approximately 650 medical records were reviewed.  Performance data results immediately accessible through the eHIVQUAL application allowed providers to use data results to prioritize improvement activities.

Facility-based results of the quality of care reviews are presented as aggregate data so that providers can evaluate overall performance rather than focus on individual cases.  Results for specific regions in New York State are provided as well, in a format that permits comparative evaluation and reference to performance standards while maintaining patient confidentiality.  The results are used to target providers for assistance and consultation, rather than to penalize.  In addition, Quality Improvement Profiles are developed for HIV programs that both receive an organizational assessment and submit their performance data.  These profiles offer a succinct overview of longitudinal data results, organizational assessment results, and capacity building activities, and suggest opportunities for improvement.
AIDS Institute quality improvement experts provide professional assistance to further strengthen quality management programs in HIV facilities throughout New York State.  They work with clinicians and administrative staff to set priorities for improvement initiatives and develop plans for quality improvement and ongoing internal quality monitoring.  AIDS Institute staff and consultants provide education in quality improvement tools and techniques, assist with the interpretation of data, and promote creative thinking by facility personnel to improve performance. Webinars and workshops that focus on specific quality of care issues are offered to all HIV programs to build capacity amongst HIV program staff and consumers. 

The Quality of Care Program has established several HIV Quality of Care HIVQUAL regional groups and clinical Learning Networks. These involve a day long meeting that emphasizes peer interactions and learning.  Structured meetings focus on quality management, also using existing performance measurement strategies.  The goals of these groups are to improve the quality of HIV services, strengthen provider infrastructure, and increase competency in performance measurement.  Ambulatory care groups currently engaged in these collaborative activities include 17 New York public hospital clinics, 12 co-located primary care programs in drug treatment clinics, 33 Part C funded community health centers, a group of 15 upstate hospitals and community health centers, and 14 adolescent providers.  These groups and learning networks also provide a forum for work on group improvement projects.

The HIV Quality of Care Program continues to engage people living with HIV/AIDS (PLWHA). The HIV Quality of Care Consumer Advisory Committee has been focusing its attention on the following areas:  involvement of consumers in quality activities, and concerns of the deaf and hard of hearing community.  In 2007, a Youth Committee was formed to solicit feedback from HIV-infected adolescents and to routinely present concerns of the Youth Committee to AIDS Institute committees.  Consumer Advisory Committee members continue to review upcoming adult, adolescent and pediatric clinical guidelines developed by the HIV Clinical Guidelines Program.

Recent areas of emphasis have included patient retention, management of patients on antiretroviral therapy, and improving clinical information systems.  Refinement of measurement strategies to enhance clinical outcomes based on available viral load and CD4 data has also become a major priority for the program as well as the capacity of all HIV programs in New York State to self-report their annual HIV performance data. Annual New York State Quality Awards honor those quality champions that have excelled in areas of quality such as performance measurement, quality improvement and consumer involvement. 

Contact:

Daniel Belanger, LMSW
Director, NYS Quality of Care Program
Office of the Medical Director
(212) 417-6131
drb08@health.state.ny.us

or

Clemens Steinböck, M.B.A.
Director, Quality Improvement Initiatives
Office of the Medical Director
(212) 417-4730
cms18@health.state.ny.us

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AIDS Intervention Management System (AIMS)

The AIDS Intervention Management System (AIMS) was created in 1986 to collect, organize, and evaluate data associated with the care of HIV-infected patients.  AIMS is responsible for utilization reviews for HIV-related inpatient stays and Medicaid-funded ambulatory care; quality of care reviews for HIV Special Needs Plans enrollees and others as requested by AI leadership or the Office of the Medical Director; and analysis and reporting of data gathered through all review activities and special studies.

The goals of the AIMS program, currently administered through a contract with Island Peer Review Organization include:

  • creation of a review process that ensures services are necessary, appropriate, and meet professionally-recognized standards of care;
  • development and management of data systems that support review activities and permit program evaluation and policy development; and
  • identification of service needs and development of mechanisms to address shortcomings or inefficiencies.

During FY 2010, AIMS conducted approximately 83,482 reviews, including 26,727 quality-of-care reviews, 53,445 utilization reviews, up to 2,427 maternal-pediatric HIV prevention and care program reviews, and 883 Special Needs Plans program reviews.  All quality-of -care reviews were conducted at ambulatory care sites.  Reviews included the piloting or implementation of over 16 different quality-of-care algorithms at acute and ambulatory care facilities.  Reviews were conducted at acute care providers other than Designated AIDS Centers in an effort to assure that all New Yorkers with HIV receive clinically appropriate services regardless of site.  Utilization reviews resulted in approximately $6.4 million in Medicaid reimbursement denials.

Contact:

Dawn Lajeunesse
AIMS Program Administrator
Office of Medicaid Policy & Programs
(518) 486-1383
dal07@health.state.ny.us

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HIV Clinical Guidelines Program

The AIDS Institute's Office of the Medical Director directly oversees the development, dissemination and implementation of state-of-the-art clinical practice guidelines.  These guidelines address the medical management and treatment needs of adults, adolescents and children with HIV infection; primary and secondary prevention in medical settings; and address the particular requirements of patients with mental health needs and substance use behaviors.  In addition, this program produces guidelines on specific issues that affect the health care needs of women with HIV infection, as well as oral health care and pharmacy issues that are associated with HIV service provision.

AIDS Institute clinical guidelines are developed by committees of expert clinicians with experience providing care to people with HIV infection in New York State.  Each guidelines committee is charged with developing standards of care for patients within its area of focus and regularly identifying guidelines topics, assessing current recommendations, and reviewing and updating existing guidelines as necessary to keep information current with any emerging clinical and research developments. All new and revised guidelines are externally peer reviewed and consumer reviewed to ensure that opinion from outside the committee is incorporated.

Current guidelines committees include:

  • Medical Care Criteria Committee (Adult)
  • Committee for the Care of Children and Adolescents with HIV Infection
  • Dental Standards of Care Committee
  • Mental Health Guidelines Committee
  • Committee for the Medical Care of Women with HIV Infection
  • Committee for the Medical Care of Substance Users with HIV Infection
  • Physicians’ Prevention Advisory Committee
  • Pharmacy Advisory Committee
  • Steering Committee

The HIV Clinical Guidelines Program works in a coordinated manner with the other programs in the AIDS Institute to promote implementation of HIV guidelines in New York State.  Clinicians are targeted through the Clinical Education Initiative (CEI) and the AIDS Education and Training Centers (AETC).  Supportive service providers are reached through the HIV Education and Training initiative, which provides training on important HIV topics to supportive service providers.  By developing quality indicators based on the guidelines, the Quality of Care program has created a mechanism for measurement of performance that allows providers and consumers to know to what extent specific aspects of the guidelines have been implemented.

As the course of the HIV epidemic evolves, it continues to present new clinical challenges.  Complex medication regimens, new testing technologies, and advances in understanding the basic science of HIV have increased both the longevity and quality of life for many patients with HIV infection.  In conjunction with these welcome changes there remains a need for continuous innovation and reliable, relevant guidance on the treatment and management of co-morbidities and an emphasis on secondary prevention strategies.  In addition, the proportion of HIV patients with specialized care needs, such as adolescents, women, an aging population, substance users and those with mental illness, is increasing as the HIV prevalent population ages.

New and updated HIV clinical guidelines are posted directly on the program’s website: www.hivguidelines.org.  All current guidelines, quality of care resources, and best practice materials related to clinical topics are available to be accessed online or downloaded.  Nearly 100 current guidelines are posted on the website--available to users throughout New York State and worldwide.

Contact:

Tracy Hatton, MPH
HIV Clinical Guidelines Program
Office of the Medical Director
(212) 417-4617
teh04@health.state.ny.us

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Part A HIV Quality Management Program

The Ryan White Part A HIV Quality Management Program provides quality improvement facilitation, measures performance in health and supportive services, and builds capacity in programs receiving Part A funding in the New York Eligible Metropolitan Area (EMA), which includes New York City and Tri-county (Westchester, Rockland and Putnam counties).  The Part A Program builds upon the existing infrastructure for quality management in New York State and integrates performance measurement of supportive service indicators -- for example, care coordination -- into the existing system of quality improvement activities developed for clinical providers.  Performance indicators measuring the quality of supportive services have been developed for many Part A service categories, and currently emphasize a focus on desired service outcomes.  Performance measurement reviews, conducted by professional peer review organizations, occur on a regular basis. The resulting performance review data are presented in aggregate and individual reports in order for programs to evaluate the systems of care at their institutions.  These reviews provide both an assessment of the effectiveness of program services and identify improvement priorities.

The quality management program has established quality learning networks as an effective and efficient model in which to provide quality improvement instruction to the very diverse Part A organizations.  The goals of these networks are to improve the quality of HIV services, strengthen provider infrastructure, and to facilitate improvement activities based on measurement.  The Learning Networks bring together participants from similar service categories to receive guidance using the peer-learning model to exchange ideas through learning network activities.  The Part A model combines quality consultation with structured meetings that focus on initiating improvement activities.  Learning Networks are currently active in the following Part A services: mental health and supportive counseling services, harm reduction, food and nutrition, medical case management (Tri-County), care coordination, and outreach to homeless youth/transitional care coordination.  Over 120 Part A programs participate in the learning networks.  

The Part A program has begun using a regional group model that brings together clinical and supportive service providers from a specific region to identify and address issues that impact HIV care in a given area to strengthen service integration and the care continuum.

Contact:

Tracy Hatton, MPH
Director, Part A Quality Management Program
Office of the Medical Director
(212) 417-4617
teh04@health.state.ny.us

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HIVQUAL-US

HIVQUAL seeks to improve the quality of care delivered to persons with HIV in ambulatory care programs in New York State, in Ryan White Part C and Part D funded programs across the U.S. and in President Emergency Plan for AIDS Relief (PEPFAR) focus countries through HEALTHQUAL International.  The HIVQUAL-US Program is a partnership between the New York State Department of Health AIDS Institute and Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, Division of Community Based Programs, which has the primary goal of building capacity and capability for quality improvement among Part C and Part D grantees of the Ryan White HIV/AIDS Treatment Extension Act of 2009.

The AIDS Institute developed a model for on-site quality improvement consultation to assist health care facilities in developing and sustaining their quality improvement programs.  Key principles of this HIVQUAL model include using aggregate data to measure performance, measuring core HIV clinical indicators based on clinical practice guidelines, and providing quality improvement (QI) consultations. Specific strategies include:

  • building internal organizational systems to sustain an HIV-specific quality management program;
  • facilitating quality improvement initiatives using multidisciplinary teams;
  • providing education about QI tools and methodologies;
  • encouraging peer learning opportunities; and
  • promoting support and commitment throughout the organization for quality.

At no cost to agencies, the program offers eHIVQUAL, a web-based application designed to capture HIV-specific indicator data and instantaneously generate reports to measure clinical performance, based on clinical practice guidelines.  To respond to changes in clinical practice, the application is continually revised to ensure its consistency with current standards of care and a group of expert providers is consulted.  Quality improvement experts are made available to participating Ryan White grantees to provide support and coaching to assist facilities in this process, and to conduct routine organizational assessments.  The 2009 national data set includes more than 100 Ryan White-funded Part C and Part D grantees (excluding those from New York State) submitting 2009 quality of care data to HIVQUAL-US, representing more than 5,000 chart reviews.

Through regional workshops and on-site consultation, providers and staff are offered education and training in organizational development to support quality improvement activities.  This approach is designed to assist HIV programs to assess their HIV service delivery system, strengthen their HIV quality program, identify areas for improvement, develop and conduct quality improvement programs, and monitor and sustain beneficial changes over time.

Contact:

Darryl Ng
Director, HIVQUAL-US
(212) 417-4533
dwn01@health.state.ny.us

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National Quality Center

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

The Office of the Medical Director coordinates the participation of several groups of stakeholders to accomplish these tasks including:  (1) an internal Quality of Care Workgroup based at the AIDS Institute, responsible for implementation and refinement of the program within the New York State Department of Health AIDS Institute; (2) the AIDS Institute's Medical Care Criteria Committee, responsible for clinical guidelines development; (3) the HIV Quality of Care Clinical Advisory Committee, comprised of expert HIV providers who advise on the development, implementation, and refinement of the Quality of Care Program; (4) the Quality Committee for HIV Medicaid Managed Care Special Needs Plans (HIV SNPs); (5) the New York City Part A Quality Management Program Advisory Committee; and (6) the AIDS Institute's Consumer HIV Quality Committees. The AIDS Institute solicits feedback through these committees in planning, implementing, and evaluating quality of care program activities.  The interaction of providers and consumers with the AIDS Institute through these various groups allows New York State to remain responsive to the needs of the communities that it serves, while responding to changes in clinical and scientific knowledge.

Statewide quality of care program standards that apply to all HIV health care facilities, regardless of their caseload, location or service delivery model have been developed, reviewed annually, and revised as needed.  These standards ensure that the best clinical care is provided to patients throughout New York State by improving systems of care delivery and by stimulating quality monitoring.  In addition to medical chart reviews, organizational assessment tools have been created to determine the extent to which these program standards have been implemented.  Annual assessments of providers’ quality management programs are conducted by AIDS Institute staff and consultants.  Data from these assessments are used to guide technical assistance and consultation to further enhance providers’ quality management programs and to develop future strategies to advance the statewide Quality of Care Program.  Statewide and regional organizational assessment reports are developed and reviewed annually to assess areas of common need.  Workshops, webinars and other opportunities for capacity building and peer learning are developed based on these findings.

All HIV programs throughout New York State were expected to self-report their quality of care performance data.  In 2009, 200 HIV programs submitted their performance data based on a review of 10,361 medical records. For the first time, the HIVQUAL review was completed online using the eHIVQUAL application.  HIV programs were able to submit their completed reviews online and to immediately access performance data results, allowing them to immediately utilize their data findings to prioritize upcoming quality activities.  Data findings were presented to various provider stakeholders and consumer representatives.  For the first time, a statewide HIVQUAL quality review of programs providing adolescent HIV primary care in 2010 was performed.  Approximately 650 medical records were reviewed.  Performance data results immediately accessible through the eHIVQUAL application allowed providers to use data results to prioritize improvement activities.

Facility-based results of the quality of care reviews are presented as aggregate data so that providers can evaluate overall performance rather than focus on individual cases.  Results for specific regions in New York State are provided as well, in a format that permits comparative evaluation and reference to performance standards while maintaining patient confidentiality.  The results are used to target providers for assistance and consultation, rather than to penalize.  In addition, Quality Improvement Profiles are developed for HIV programs that both receive an organizational assessment and submit their performance data.  These profiles offer a succinct overview of longitudinal data results, organizational assessment results, and capacity building activities, and suggest opportunities for improvement.
AIDS Institute quality improvement experts provide professional assistance to further strengthen quality management programs in HIV facilities throughout New York State.  They work with clinicians and administrative staff to set priorities for improvement initiatives and develop plans for quality improvement and ongoing internal quality monitoring.  AIDS Institute staff and consultants provide education in quality improvement tools and techniques, assist with the interpretation of data, and promote creative thinking by facility personnel to improve performance. Webinars and workshops that focus on specific quality of care issues are offered to all HIV programs to build capacity amongst HIV program staff and consumers. 

The Quality of Care Program has established several HIV Quality of Care HIVQUAL regional groups and clinical Learning Networks. These involve a day long meeting that emphasizes peer interactions and learning.  Structured meetings focus on quality management, also using existing performance measurement strategies.  The goals of these groups are to improve the quality of HIV services, strengthen provider infrastructure, and increase competency in performance measurement.  Ambulatory care groups currently engaged in these collaborative activities include 17 New York public hospital clinics, 12 co-located primary care programs in drug treatment clinics, 33 Part C funded community health centers, a group of 15 upstate hospitals and community health centers, and 14 adolescent providers.  These groups and learning networks also provide a forum for work on group improvement projects.

The HIV Quality of Care Program continues to engage people living with HIV/AIDS (PLWHA). The HIV Quality of Care Consumer Advisory Committee has been focusing its attention on the following areas:  involvement of consumers in quality activities, and concerns of the deaf and hard of hearing community.  In 2007, a Youth Committee was formed to solicit feedback from HIV-infected adolescents and to routinely present concerns of the Youth Committee to AIDS Institute committees.  Consumer Advisory Committee members continue to review upcoming adult, adolescent and pediatric clinical guidelines developed by the HIV Clinical Guidelines Program.

Recent areas of emphasis have included patient retention, management of patients on antiretroviral therapy, and improving clinical information systems.  Refinement of measurement strategies to enhance clinical outcomes based on available viral load and CD4 data has also become a major priority for the program as well as the capacity of all HIV programs in New York State to self-report their annual HIV performance data. Annual New York State Quality Awards honor those quality champions that have excelled in areas of quality such as performance measurement, quality improvement and consumer involvement. 

Contact:

Daniel Belanger, LMSW
Director, NYS Quality of Care Program
Office of the Medical Director
(212) 417-6131
drb08@health.state.ny.us

or

Clemens M. Steinböck, MBA
Director, Quality Improvement Initiatives
Office of the Medical Director
(212) 417-4730
cms18@health.state.ny.us

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HEALTHQUAL-International

HEALTHQUAL International is a capacity building initiative to strengthen and improve national health systems with the goal of creating self-sufficient local quality management programs that are sustainable over time. Quality improvement activities involve clinic staff and consumers with support from Ministry of Health leadership.  These structural features are designed to be lasting even with staff turnover, organizational leadership changes or political transitions. HEALTHQUAL International is funded through the President’s Emergency Plan for AIDS Relief (PEPFAR) in 12 countries in Africa, the Caribbean, and South America.   

HIVQUAL-International was launched in Thailand in 2003, quickly expanding globally to PEPFAR focus countries including Uganda, Mozambique, Namibia, Haiti, Nigeria, Guyana, Kenya, Swaziland, Botswana, and Rwanda, with expansion to Vietnam and Zambia currently underway.  Based on the quality management model developed by the New York State Department of Health AIDS Institute in 1995, the HIVQUAL model has been successfully adapted by Ministries of Health and implemented by country teams throughout these regions. In 2010, HIVQUAL-International transitioned to HEALTHQUAL, a programmatic development reflecting our expanded focus on a public health approach to quality management, including and extending beyond HIV care, to encompass other chronic and infectious diseases.  The methodology between HIVQUAL and HEALTHQUAL is identical, with HEALTHQUAL characterized by a broader focus on population health to strengthen overall quality of care across national health systems.

HEALTHQUAL adapts three basic components of quality management – performance measurement, quality improvement, and the quality management program – into a national program directed by the Ministry of Health and led by teams who are mentored by HEALTHQUAL staff, augmented by peer learning models and patient involvement.  This includes coaching, provision of training, technical assistance, paper-based tools and software to country programs for both monitoring and documentation of the quality of patient care. Staff and consumer involvement support government-led capacity for the scale-up of HIV treatment and care and advancement of overall population health.  Regional and district quality management groups foster implantation within structures of local government, creating expectations for ongoing, sustainable programs and rapid spread through peer learning.

Contact:

Richard E. Birchard, MS
Deputy Administrative Director - HEALTHQUAL International
HIVQUAL-International Program
Office of the Medical Director
(212) 417-4749
reb08@health.state.ny.us

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Special Projects of National Significance

The HRSA HIV/AIDS Bureau (HAB)‐sponsored Special Projects of National Significance (SPNS)aims to support the development of innovative models of HIV care that respond to the emerging needs of Ryan White HIV/AIDS Program clients. In 2011, HAB launched the SPNS for Systems Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative. This multistate initiative will address issues of access to and retention in high quality HIV care through the development and dissemination of effective and sustainable systemic linkage models.

This SPNS Initiative, called NY Links, is funded for 4 years. The goal is to create, evaluate, and improve models of systemic linkage that optimize existing cross‐agency HIV‐related services in order to improve linkage to care and retention in care of people living with HIV/AIDS.

Successful models will demonstrate:

  • An increase in the number of people living with HIV who know their serostatus
  • An increase in the number of newly diagnosed individuals linked to care within three months of diagnosis
  • An increase in individuals living with HIV who are virologically suppressed
  • An increase in number of individuals living with HIV retained continuously in HIV/AIDS care

Linkage models are rigorously evaluated using state‐specific indicators and successes will be used for state‐wide dissemination. In addition, all demonstration states are part of a multi‐state evaluation effort led by the SPNS Evaluation and Technical Assistance Committee (ETAC) at University of California at San Francisco (UCSF).

New York State SPNS Initiative – NY Links

The aim of the New York State Systems Linkages Project is to bridge systemic gaps between HIV related services within New York State in order to achieve better outcomes for people living with HIV/AIDS (PLWHA) by improving systems for monitoring, recording, and accessing information about HIV care in NYS. In Years 1 and 2 (2011-2012, 2012-2013), three successive “Waves” of Collaboratives composed of traditional and non‐traditional healthcare and supportive services providers in specific high incidence communities produce a learning environment in which systemic collaboration and linkage innovations can be tested and measured. In Years 3 and 4, a statewide scale‐up of strategies shown to have promise during the Collaborative phase, as well as a subsequent evaluation of their effectiveness and sustainability, are conducted. Ultimately, the development and scale‐up of these interventions foster communication between service providers and encourage the removal of barriers that limit the effective use of data systems. This facilitates the entry into and continuation in HIV care by those who are unaware of their status and by those who are aware of their status but have not entered care or who are no longer retained in care. Key partners in this Initiative include the NYS Division of Epidemiology, Evaluation and Research, the New York City Department of Health and Mental Hygiene, and Hunter College. Representatives from the New York City Health and Hospitals Corporation, NYS Consumer Advisory, Clinical Advisory and Young Adult Consumer Advisory Committees will participate in an advisory capacity.

Structure of New York State Activities

Years 1 & 2

The first two years of this Initiative focus primarily on implementation of three Waves of Collaboratives, each lasting 12‐18 months, beginning in the Upper Manhattan and Western New York regions. Collaboratives consist of representatives from various service categories, Ryan White funding streams, surveillance units, community groups, and consumers. Each Collaborative is conducted regionally and in parallel. Each Collaborative is tasked with forging partnerships across funding streams, program areas and providers to develop a catalogue of proven strategies to link HIV‐infected individuals to HIV care. The work of every Collaborative is thoroughly evaluated using available performance data and pre‐approved quality indicators. Models and interventions proven to be highly successful are determined and integrated into previously existing NYSDOH collaborative frameworks.

Years 3 & 4

The second two years of the NYS SPNS Initiative turn toward statewide implementation and evaluation of successful interventions. The AIDS Institute uses a multifaceted approach to bring the lessons on linkage to care learned in the first two years to providers and consumers across the state and outside of the Collaborative model. Additionally, the sustainability and effectiveness of these interventions on a state‐wide level are evaluated. To foster implementation and peer learning of successful strategies identified by face‐to‐face Collaboratives, the AIDS Institute utilizes the following approach:

  • Hold statewide conference calls and webinars
  • Hold statewide conference calls to highlight key concepts
  • Develop web‐based modules on linkage and retention through the NQC Quality Academy
  • Publish and disseminate resources on linkage to care using websites, project space and targeted mailings

Surveillance and Data Systems

Another principal aim of this project is to integrate and strengthen state and city data systems to improve the quality of available data on linkage and retention. Data from routine assessments of linkage and retention measures at a local agency level, from the larger systems of HIVQUAL, AIRS, Medicaid and NYC and NYS Epidemiology/Surveillance, as well as from the short‐term Collaboratives, will all ideally be linked with a focus on linkage to care and retention measures. Ultimately, the long‐term coordination of these data systems will facilitate the provision of quality information to NYC & NYS surveillance systems and of wide‐ranging high quality care to all populations of PLWHA in NYS.

Evaluation

The evaluation effort for the SPNS Initiative will be led by Hunter College. Data on core project indicators are collected from the Collaboratives, control sites as well as existing data sources to analyze trends in key testing, linkage and retention outcomes. The overall evaluation component of this initiative aims to:

  • Evaluate the effectiveness of strategies piloted in the Collaboratives to improve outcomes related HIV diagnosis, linkage, engagement and retention in high quality HIV care
  • Evaluate the statewide impact of dissemination and scale‐up of strategies found by the Collaboratives to be effective in improving outcomes
  • Participate in and contribute to the multi‐state evaluation process.

End Goals

At the completion of this 4‐year SPNS Initiative, the AIDS Institute aims to have:

  • facilitated new levels of collaboration between agencies and organizations providing HIV services in NYS;
  • identified, assessed and scaled‐up innovative interventions that have proven successful in linking patients to care;
  • integrated these innovations into existing networks and services statewide;
  • coordinated existing data systems within New York State to better analyze and improve linkage and retention; and
  • established clear performance measurements to allow for routine and accurate monitoring of HIV care across New York State.
Contact:

Steven Sawicki, MHSA
Office of the Medical Director
(518) 474-3813
svs03@health.state.ny.us

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