NQC Launches its First National in+care Campaign
Retention in HIV care is a powerful predictor of survival, yet many HIV patients are lost to care. In line with the White House Office of National AIDS Policy’s goal to seamlessly “link people to continuous and coordinated quality care when they are diagnosed with HIV,” we launched our first ever national retention campaign. The campaign had three overarching goals: build provider networks, bring patients back to care, and keep other patients from falling out of care.
Overview of the in+care Campaign:
- Voluntary participation by Ryan White grantees
- Routine online reporting of performance data on four performance measures with real-time benchmarking functionality
- Routine reporting of improvement strategies and challenges
- Monthly webinars to provide content expertise and promote peer sharing, including journal clubs by renowned researchers outlining findings from recent publications
- Quality Champions to lead regional/local meetings of Campaign participants
- Consumers were involved via a Partners in+care component
The Technical Working Group of 25 distinguished retention experts was formed on October 5, 2011 under the leadership of Drs. Laura Cheever and Bruce Agins. The group developed national retention measures. These measures were subsequently endorsed by the HIV/AIDS Bureau and the National Quality Forum (NQF). Kathleen Sebelius, former Secretary of Health and Human Services, approved 3 out of 4 measures for the use of seven common core measures for monitoring HHS-funded HIV prevention, treatment, and care services.
Map of in+care Campaign participants as of January 2014 (Note: Red dots represent providers; gray dots represent consumers).
Successes of the in+care Campaign:
- By 2014, the in+care Campaign was the largest U.S. quality improvement project in HIV care
- To date, 655 providers and agencies joined the campaign, representing 51% of all Ryan-White grantees
- Statistically significant improvements were seen in national retention and viral suppression performance rates:
- Gap in care appropriately decreased from 14.1% to 10.8%
- Medical visit frequency increased from 65.8% to 74.9%
- New patient retention increased from 60.3% to 66.1%
- Viral load suppression increased from 70.0% to 76.4%
- There have been 24 newsletters and 57 webinars with an average of 50 participants per webinar; which have been used to teach grantees and providers how to improve their capacity and capability for improving retention
- There were 42 individuals who volunteered as Local Quality Champions in 25 distinct regions of the U.S.
- Roughly 700 individuals signed up as Partners in+care
Chart of performance scores for the in+care viral load suppression measure (the number of patients ranged between 117,471 and 160,804 per data submission).
To learn more about this successful national initiative, read the detailed in+care Campaign impact study, and to access retention resources and tools | incareCampaign.org
Ryan White grantees within the Washington, DC Eligible Metropolitan Area (EMA), which includes grantees in DC, Maryland, Virginia, and West Virginia, face challenges in implementing quality improvement efforts because of unique geographic and constituency considerations. Because consumers move fluidly between different states and programs that independently service their respective geographical areas, adherence, retention, data management, and coordination of care are common challenges across programs. With this in mind, NQC, along with the HIV/AIDS Bureau, created the DC Cross-Part Collaborative. The goal was to strengthen the regional capacity for collaboration across Ryan White Program Parts and align quality management goals with legislative mandates.
Overview of the DC Collaborative:
- Included 17 Ryan White grantees across all Program Parts
- Had the potential to impact roughly 9.4% of people living with AIDS in the U.S.
- Held five face-to-face learning sessions where participants learn from each other, share experiences, and develop new plans for action
- Webinars facilitated communication within teams
- Routine reporting on a uniform set of outcome, process, and individual measures
- Quality improvement projects were conducted and quality management infrastructure updates were discussed
- The Collaborative included an EMA-wide, cross-Part quality improvement training to assist providers and consumers to build increased quality improvement capacity
- Collaborative assessments were conducted at baseline and then quarterly to assess the quality management infrastructure development
Table regarding the adoption of key quality management infrastructure elements over the course of the DC Collaborative.
Successes of the DC Collaborative:
- For the first time, all grantees in the DC EMA area worked jointly together on quality improvement
- All 10 quality management infrastructure elements were in place by May 2012
- Performance data on seven core medical measures showed improvements overall, with significant improvement seen in viral load suppression, PCP prophylaxis, and syphilis screening
- Improved collaboration and alignment across Ryan White grantees as evidenced by improved collaborative assessment scores
- Demonstrated sustainability over time, as seen in ongoing Collaborative activities
Table of performance data submitted by participants in the DC Collaborative.
To learn more about the DC Collaborative and findings of the DC Collaborative impact study |NationalQualityCenter.org/nqc-activities/collaboratives/dc-collaborative/