The Issue

Advances in the treatment of HIV/AIDS have made it possible for the next generation to be AIDS-free, but this cannot happen unless we can prevent new infections from occurring and stop HIV-positive individuals from developing AIDS. And this can only happen with treatment, yet according to the Centers for Disease Control and Prevention, only about 25 percent of individuals with HIV in the United States are successfully keeping their virus under control.

In 2010, PRHI analyzed Pennsylvania Health Care Cost Containment Council (PHC4) data to understand the reasons for hospital admissions and readmissions in southwestern Pennsylvania for HIV-positive individuals in order to identify opportunities for improving care and reducing avoidable admissions. In 2012, we expanded this research to include an additional year of data, but also additional analysis of patterns of patient admissions over time.

Data confirmed that, as a result of the development of more effective HIV medications, life expectancy at diagnosis has increased dramatically, transitioning HIV into a chronic disease that needs to be managed. The picture that emerged was one of extraordinarily complex patients, with conditions ranging from HIV-related infections to comorbid common chronic diseases to the side effects of mental illness, drug abuse, and the medications used to treat HIV itself.

PRHI Readmissions Brief: Patterns of Hospitalization Among HIV-Positive Patients in Southwestern Pennsylvania; April 2012 Update

In addition, many people with HIV/AIDS avoid diagnosis, enter treatment but then stop complying, or avoid prescribed treatment altogether. We call them “lost to care.” This has serious consequences for them, for their partners, for their living or unborn children, and for the economy.

The Solution

As part of the JHF fiscal agency, in April 2012, the Jewish Healthcare Foundation (JHF) was awarded a $1.4 million, two-year grant from the Pennsylvania Department of Health to tackle this difficult problem. Through the Minority AIDS Initiative (MAI), JHF is working with twenty AIDS Service Organizations (ASOs) across the state to improve the quality of patient services, develop or strengthen programs to re-engage individuals lost to care, and reduce avoidable hospital readmissions for persons with HIV/AIDS.

The Jewish Healthcare Foundation is the parent organization of PRHI, and serves as regional fiscal agent for HIV/AIDS funding. The staff of JHF and PRHI works collaboratively across multiple initiatives such as MAI.

Each ASO is receiving extensive training and coaching in order to improve the quality of outreach services. Many organizations already work hard to re-engage individuals lost to care, but most did not have access to the program models, staff training, or quality improvement systems necessary to do so effectively. Programs for effective outreach exist, and MAI training and coaching is geared to helping organizations adopt a specific model or develop their own based on the core components of existing models.

MAI has trained and coached outreach workers (peers, medical assistants, social workers, etc.) in Motivational Interviewing techniques and skills (evidence and models indicate that Motivational Interviewing is an effective tool for treatment adherence, engagement in testing, and engagement in care) so that they can effectively reach out to individuals lost to care. ASOs have also been trained in Perfecting Patient CareSM (PPC), the flagship quality improvement system developed by PRHI.

The Minority AIDS Initiative (MAI) kicked off December 11-13, 2012 with 15 ASOs receiving their first training sessions in PPC, data collection and reporting, and motivational interviewing. Additionally, the ASOs were provided with iPads containing customized tools, enabling them to be more efficient and effective in linking HIV-positive individuals to care. Use of the iPads will reduce duplicative paperwork, enable data aggregation across the state, and allow JHF to provide valuable resources to all ASOs electronically.

This training has been followed by on-site and virtual coaching to help organizations add the new components into their daily workflows. Through Phase One of implementation, weekly on-site or electronic contact is made between the coaches and organizations. Additionally, a series of webinars on topics relevant to the MAI have been offered.

In December 2013, five additional ASOs were added to the MAI project, bringing to 20 the total number of agencies across the Commonwealth working to engage HIV-positive high-risk and lost-to-care individuals.

In February 2014, PRHI researchers completed a report for the Pennsylvania Minority AIDS Initiative exploring HIV/AIDS hospital admissions and readmission data for the entire Commonwealth. By analyzing Pennsylvania Health Care Cost Containment Council (PHC4) data on all hospitalizations of HIV-positive patients between July 2010 and October 2012, and comparing the results to public health data on the HIV-positive population across Pennsylvania counties, the report points out what groups of patients are most likely to have experienced hospital admissions or readmissions (both can be indicators of missed prevention opportunities). Furthermore, the report also documents striking variations across PA counties and hospitals in admission and readmission rates, especially in Pennsylvania’s non-urban counties. Both sets of findings can be used to help providers target outreach to vulnerable patients and to help policy makers ensure that all PA providers have the information needed to provide appropriate primary care for people living with HIV/AIDS.

Using Hospital Admission and Readmission Patterns to Improve Outreach to Patients Living with HIV/AIDS in Pennsylvania; February 2014

Measure of Success

The focus of MAI is on individuals with HIV/AIDS who are not in treatment. The goal is to get those HIV-positive individuals not receiving treatment on antiretroviral drugs which keep them healthy and out of the hospital. Working with each of the individual sites to improve their work processes will improve patient care, reduce costs, and free up capacity for better outreach. Consistent with the purpose of the funding, this program seeks to eliminate racial and ethnic disparities in health by targeting beneficial educational services to persons living with HIV/AIDS from racial and ethnic minority groups.

Results to Date

Surpassed the MAI Initiative 18-month goal in the first year (which was to re-engage 450 HIV+ individuals who were lost-to-care).

Richard Smith
HIV/AIDS Program Manager
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