national quality center (nqc)1 rw grantees in washington, dc presentation “recapture blitz”

National Quality Center (NQC)1

RW Grantees in Washington, DC

Presentation

“Recapture Blitz”


Recapture “Pilot” at Family & Medical Counseling Services

Objectives:• Recognize barriers to care• Identify customized solutions

Defined by staff Defined by clients Defined resources


Overview of FMCS Statistics

• 1997 652 clients

• 450 active medical clients (unduplicated/year)• Lost to follow up : 200*

• 2005 864 clients

• 687 active medical clients• Lost to follow up : 122*

• 2007-8 1100 clients unduplicated medical clients Lost to Follow up: 190* *(alive and well)


Lost to Follow Up Client Identification Process

• Chart review• Utilizing New EMR

Missing numbers on review Missing from staff reports Seen in Outreach Request for Medical records

• Calls from other providers• Hospital admissions


Lost to Follow-up Contact

Clients Identified as Lost to Follow-Up were contacted via:

• Telephone• Outreach van• Home visits• Letters• More telephone calls


Patient Reported the Following Reason’s

• “Just stopped coming”• “Problems with a staff member”• “ don’t know”• “Got tired of taking pills”• Relapse• Moved, so clinic too far• Incarcerated


Reasons Clients Returned

• Incentives Gift cards Food vouchers

• Needed to know we still cared• Readiness for care• Not treated as well in other places


Target Outreach to Get Clients Back in Care

• Recapture Program Time: 4 months Telephone contacts: 246

• Many duplicate calls or repeat contacts

Outreach contacts: 97 Home visits: 30

• lost adherence team secondary to funding so fewer home visits

• Case Managers/ Outreach team given comp day for 3 clients scheduled and met in med dept.


Factors for Continued Growth

• 1. Adherence team 2 peer educators

• Follow up phone calls• Abn lab letter• Home visits

• 2. Medical CM /Outreach Adherence Team Follow up phone calls Home visits Incentives for continued service


Individualized Care Plan

• Optimize Care with Individualized Service Make available : tokens, metro pass Increase medical availability Treat mental health issues Simplify insurance criteria Incentives Close client contact on a daily basis Reduce stigma Develop social resolution strategy/support groups daycare


Key Factors to Successful Long Term Care

• Individualized care• Face to face contact• Reassurance• Ease of service• Stabilization• Resolution of social barriers

Decrease homelessness Decrease social stigma Decrease co-morbid conditions


Results After 4 Month Initiative

• 190 Initially lost to care• 116 returned to care at FMCS• 40 in other clinics• 44 still lost

61 % recovery rate 82 % in care 23 % attrition

• Clinic continues to follow initiative protocol though no further funding for intensive work


• The District of Columbia Department of Health HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) has put an increasing focus on Promotion and expansion of testing Linkage to and re-engagement in care Retention in care with improved health outcomes

• The “4Rs” Recruitment/Navigation into care Recapture Retention and Results


Recapture Blitz 2009

• In 2008 HAHSTA gave sub-grantees a mission to

“Recapture” those lost to care

• Providers competed for MAI funds from HAHSTA to

implement recapture activities

• FMCS developed an effective model that was

identified as best practice

• In 2009 HAHSTA called for a “Recapture Blitz” to

scale-up the model



• Two thirds of the major HIV public sector

providers in DC participated in the Blitz

• This was a “Cross-Part” initiative, including

providers that are all funded through Ryan

White, but have a mix of A, B, C and D.


Recapture Blitz 2009: Two phases

1. Identification and prioritization of the client cohort to be recaptured ( August 2009)

a. Compilation of client lists by providers

b. “Matching” against HAHSTA databases

2. Implementation of client contact and re-engagement in care ( September to December 2009)



Providers compiled client lists using the definition as lost to care meaning out of care for 6 months or more up to 2 years Some providers opted for > 2 years



HAHSTA performed “Matching” against internal DOH databases using either the most recent lab test or “prescription fill date”

• Determined clients lost to care at a system level • Prioritized which clients could be contacted first

based on time out of care• Clients were matched to the following datasets:

CDC HIV surveillance, ADAP and laboratory databases


Recapture Blitz: Matching Results

Indicator Number Percent

Total clients submitted to HAHSTA as “lost”

2642 100%

Clients found to be active somewhere within 6 mos

894 34%

Clients found to be active somewhere over 6 mos

961 36%

Clients not found in databases 740 28%

Clients found to be deceased 47 2%


Recapture: Matching Results

• Of 2642 thought to be lost by providers, 537 or 20% of the clients were seen by a different agency than who declared them lost.

• 20% of clients who providers thought were lost were actually seen somewhere else


Recapture Blitz: Implementation

Implementation of client contact and re-engagement in care ( Sep – Dec 2009)

• Providers used the revised list provided by HAHSTA to contact clients. They prioritized those active within 6 months, but also began to contact clients in the over 6 month category.

• To date, we have data from 5 providers and are still awaiting results from 3. The 5 providers had a total of 1365 clients lost to care.


Recapture Blitz: Preliminary Data

Indicator Number Percent

Number of clients providers attempted to contact

982 100%

Number of clients actually contacted

404 41%

Number of clients reported that they were already in care

230 23%

Number of clients who made appointments

186 19%

Number of clients who kept appointments

? ?


Next steps• Collection and analysis of ongoing and

updated data• Assessment and development of tools

Providers need going forward• Recapture Summer Blitz

national quality center (nqc)1 rw grantees in washington, dc presentation “recapture blitz”

Documents

national quality center

incarcerated slide

continued service slide

followup contact clients

intensive work slide

medical records calls

outreach adherence team

lost adherence team