Transcript Document

BINGHAMTON PRIMARY CARE
PATIENT RETENTION PROJECT
Community Diagnosis:
Risk for negative health outcomes in
the HIV community including
increased viral load, drug resistance,
and/or increased incidence of
transmission caused by “loss to
follow up” or missed appointments r/t
transportation troubles, lack of
appointment awareness, lack of
childcare, or other personal issues
as demonstrated in an 85% retention
rate for UHS Binghamton Primary
Care HIV Clinic
Problem Analysis:
Care retention
“Engagement in HIV care is increasingly
recognized as a crucial step in maximizing
individual patient outcomes.” (Mugavero,
2010)
Missed visits are common and can be
complicated by unreliable phones, difficulty
with transportation, and need for frequent
visits
“Case management is a mediator in the
pathway by which case management affects
retention and, consequently, survival among
patients with HIV/AIDS.” (Ko, 2011)
Methods
• A letter sent to selected patients said “You must call us to
• Quasi-experimental interrupted time series design
schedule your appointment before March 31, 2013, to be
• O1 X O2
eligible for your gift card. That’s it, that’s all you have to do!”
• Independent variable: attendance at quarterly appointment,
• Mailed on February 15th, 2013
completed quarterly lab work
• Creation and maintenance of a spreadsheet with participating
• Purposive sample of patients at high risk for loss-to-follow up
patients and their progress toward goals
Selection criteria included
• Creation and maintenance of a log of clinical process evaluation
• No appointment made or kept in the last 3 months
to be updated as needed by HIV team members to identify
• No lab work done in the last 3 months
strengths and weaknesses related to the process of the project
• Poor medication adherence – some identified through pharmacy
(i.e. patient comments and complaints, staff comments and
verification
complaints, logistic issues, etc.)
• Patients identified by Team as high risk for adherence to care due • Creation of a personalized card to be given to the patient along
to past behavior
with their gift card incentive
Methods
• Sample size of 30 selected based on existing size of “hot list”
Results:
• Additional 10 patients added due to poor initial response
Retention rate in target population increased from 35% to 50%
Data Collection
during project
• Weekly collection of data including those who attended
Pilot Population Retention Rate
appointments, lab work
• Maintenance of process evaluation
• Descriptive data of population including past history of
appointments and “no shows,” comorbidities, social habits
60%
50%
40%
30%
Pilot Population Retention Rate
20%
Binghamton Primary Care HIV Patient
Population
Male
Binghamton Primary Care Patient
Retention Pilot Project
Female
Male
10%
Female
0%
Before
After
36%
42%
58%
64%
Long term goal: To improve patient care
outcomes by improving patient retention and
adherence.
Short term goal: To maintain 90%
adherence to lab work and scheduled
appointments in the chosen patient
population from February 11, 2013-April 30,
1013 by way of offering incentive gift cards.
Binghamton Primary Care HIV
patient population
10%
42%
Binghamton Primary Care Patient
Retention Pilot Project
17%
18-29
14%
18-29
31%
30-39
30-39
40-49
40-49
20%
50+
34%
The Project:
50+
32%
100%
100%
90%
90%
80%
80%
70%
70%
60%
50%
No Drug Use
40%
Drug Use
30%
Axis Title
Axis Title
Offering an incentive to a subgroup of the HIV clinic
patient population in the form of a $10 gift care to
Weis Markets.
To earn this incentive, the patient had to attend their
routine HIV care appointment AND get their lab work
done between the target dates.
The HIV team identified 26 patients from a list called
the “hot list,” which is updated weekly.
Implications
• A low-cost intervention can
have a great impact on care
retention
• Care retention is a global
predictor of improved health
outcomes in HIV patients
• Improved health outcomes in
HIV patients can result in better
overall health, and reduced
health costs
• Improved health outcomes in
HIV patients can result in fewer
comorbidities, and fewer
emergent health problems
• Providing incentives to patients
at risk for reduced adherence
to care can be a cost effective
way to improve current and
future health outcomes
60%
50%
No Tobacco Use
40%
Tobacco Use
Recommendations
• Maintenance of certain data
markers to help determine
when each patient is due for
appointments
• Maintenance of certain data
markers to help determine
which patients may benefit
most from a targeted
intervention
• Gathering feedback from
patients about incentives that
may work best
• Outreach such as a phone call
to remind patients to schedule
appointments
• This measure may also be
helpful in determining those
patients who are at risk for
discharge from care
30%
20%
20%
10%
10%
0%
1
BPC HIV Population
2
BPC Pilot Patient Population
0%
1
BPC HIV Population
2
L-R: L. Natik, K. Dodge, N. Tucker, G. Immerman
BPC Pilot Patient Population
Poster by Rosemary Collier, RN, MS projected May 2013, Decker School of Nursing, Binghamton University
Special thanks to the UHS Binghamton Primary Care HIV Team including Kate Dodge, RN; Laureen Naik, RN; Nicolle Tucker, MCM; LuAnn Morlando, Data Coordinator; Greta
Immermann, HIV Program Coordinator; Scott Rosman, CNP; and Ryan Little, FNP, AAHIVS