SPECTRuM: Nurses
and Peers in
Partnership
October 17, 2013
For Audio: Dial-in#: 866.394.2346
Participant Code: 397 154 6368#
Agenda
Michael Hager
in+care Campaign Manager
National Quality Center
New York, NY
[email protected]
 Welcome & Overview- 5 mins
 SPECTRuM: Nurses and Peers in
Partnership – 35 mins
 Discussion on Peer Integration, 15
mins
 Wrap-up & Evaluation, 5 mins
Conversation opportunities throughout webinar
2
Welcome & Overview
 This Partners in+care webinar is offered as part of the
in+care Campaign.
 The in+care Campaign is a national effort to improve
retention in HIV care.
 Webinars are one of many Partners in+care activities
designed to engage people living with HIV/AIDS and their
allies in the in+care Campaign.
For more information: www.incarecampaign.org
3
Participation Guidelines
 This is a “public event.” If you have confidentiality
concerns:
 Your names appear on-line in the list of webinar registrants
-consider just listening to the audio or to viewing the webinar at a
later time, after it is posted at www.incarecampaign.org
 All webinars are recorded - do not use identifying information
when asking questions
For Audio: Dial-in#: 866.394.2346
4
Participant Code: 397 154 6368#
Participation Guidelines
 Actively participate and write your questions into the chat
area during the presentation; we will also have a “pop up”
question exercise, and will pause for conversation during
the webinar
 Do not put us on hold
 Mute your line if you are not speaking (press *6, to
unmute your line press #6)
 The slides and recording of this and other Partners in+care
webinars are available for playback and group
presentations at www.incarecampaign.org – “Resources” tab
For Audio: Dial-in#: 866.394.2346
5
Participant Code: 397 154 6368#
Peer Integration
Pop-up Question
Have you ever used Peers in
the delivery of services in
your clinic or organization?
Yes
No
Visit www.incarecampaign.org
6
Peer Integration
Pop-up Question
Are Peers currently
providing services in your
clinic/organization?
Yes – volunteers
Yes – part time staff members
Yes – full time staff members
No
I don’t know
Visit www.incarecampaign.org
7
SPECTRuM – Nurses and Peers in Partnership
• Sophie Lewis
• Director of Service Development, Massachusetts
DPH Bureau of Infectious Disease Office of
HIV/AIDS
• Noelle Cocoros
• Director of Research and Evaluation,
Massachusetts DPH Bureau of Infectious Disease
8
Strategic Peer-Enhanced
Care and Treatment
Retention Model
Peers and Nurses in Partnership
The Massachusetts SPECTRuM Project
October 17, 2013
9
Background


Massachusetts Department of Public Health
(MDPH) is one of six states participating in the
SPNS Systems Linkage and Access to Care for
Populations at High Risk of HIV Infection
Initiative
Emphasis is on systems-level changes, use of
surveillance data (electronic lab reporting), and
innovative organizational and staffing practice.
10
Federal and State Goals
National HIV/AIDS
Strategy:



Reduce HIV incidence
Increase access to care
and optimize health
outcomes
Reduce HIV-related health
disparities
Office of HIV/AIDS State
Plan



Reduce new HIV and HCV
infections
Improve health outcomes
Reduce disparities in HIV
and HCV incidence and in
health outcomes
National Trends:
 Test and treat, treatment as prevention, Prevention with Positives
 The “Care Continuum”
 Public health obligation to use available data, e.g., lab reports
1111
MA Consumer Care Experience
(Self-Report; N = 1,004)
100
90
80
70
60
50
40
30
20
10
0
In medical
care
Taking HIV
medications
Virally
suppressed
Health good
to excellent
12
Source: Massachusetts and Southern New Hampshire HIV/AIDS Consumer Study Final Report, December 2011, JSI Research and Training, Inc.
How can we advance linkage and
care engagement?



Expand Routine HIV testing
Strengthen connections
between prevention, testing,
and care programs
Use public health and
clinical data to drive and
inform program response
13
Integration of Peers



The Office of HIV/AIDS (OHA) has a long history
of including people living with HIV in the
planning and development of services and
policies that impact the consumer community
In the past few years OHA has expanded peer
services and enhanced the role of peers
The majority of OHA sites funded for medical
case management have interdisciplinary teams
that include fully integrated peers
14
SPECTRuM—Three Strategies

Peer/Nurse linkage team

HIV Surveillance—Program
Feedback Loop

Systems-level initiatives to increase
access to HIV testing and awareness
of HIV status
15
Current Sites:
Three pilot sites – all offer both strategy 1
and strategy 2:

Boston Medical Center
 Large urban hospital with approximately 1400 HIV+ patients
Holyoke Health Center
 Small community based health center in western MA with
approximately 225 HIV+ patients
University of Massachusetts Medical School
 Large teaching hospital with three sites in central MA serving
a total of approximately 750 HIV+ patients
16
Expansion Sites

Two expansion sites, both offer strategy 2:
 Morton Hospital
 Small community hospital with strong ID expertise. Attracts
patients from more rural areas of the state
 Brockton Neighborhood Health Center
 Urban community health center in South Eastern MA. Serves
many non-US born, low income patients

One expansion site scheduled to start this fall,
will offer both strategy 1 and strategy 2
 Community
health center in South Eastern MA,
serves IDU, non-English speaking patients.
17
SPECTRuM Strategy 1:
The Peer-Nurse Linkage Team




Peer and nurse have distinct and equally
important roles
Peer brings experience, knowledge and
understanding with the credibility of being from
the community
Nurse provides clinical expertise and support
As a team they offer a flexible and responsive
service model:
 Tailored services to individual needs
 Service adjustments based on data
18
SPECTRuM Services Include…

Medical Care Coordination
 Appointment
reminders and/or follow up on missed
appointments
 Transportation
 Preparation for medical appointment
 Accompaniment to medical appointment and
phlebotomy lab on request
 Debrief of medical appointment including discussion
of medications and lab results
19
SPECTRuM Services Include…
Mental health assessment and referral
 Substance use assessment and referral
 Housing assessment and referral
 Treatment adherence support
 Health Literacy
 Sexual health promotion
 Coordination and/or referral for benefits,
food services, legal services, and other
support services needed

20
What Makes SPECTRuM Strategy 1
Different from Medical Case
Management?

SPECTRuM is:
 Short
term
 Time limited
 Intensive

SPECTRuM staff:
 Includes
team of nurse and peer
 Have small case loads (about 20)
 Have frequent (a minimum of bi-weekly)
interaction with clients
21
SPECTRuM Strategy 1 Services
Eligibility and Referral

High acuity patients
 Poverty,
homelessness, mental illness, substance use,
domestic violence, advanced disease, etc.




Recently released ex-offenders
New arrival immigrants or refugees (past five
years)
Newly diagnosed individuals
History of missed appointment or interruptions in
care
22
SPECTRuM Strategy 1 Services
Eligibility and Referral



Persons recently in recovery or actively using
drugs/alcohol
Clients recommended for any reason by
member of care team
Identified through State Surveillance system
(strategy 2)
 Patients
 Patients
with detectable viral load
with gap of 120 days or more in submission
of CD4 and viral load labs
Strategy 1 enrollment requires consent
23
SPECTRuM Strategy 1 Services
Transition


Goal is to transition clients out of SPECTRuM
after six months
At six month mark acuity tool is administered
and service plan is reviewed
 Stable
clients may transition to case management,
peer support, or self management
 High acuity client may stay in SPECTRuM
24
Strategy 2
Surveillance-Program Feedback Loop


CD4 T-cell counts and HIV viral load results
reportable to MDPH as of January 2012
Regular reports from MDPH HIV Surveillance
Program to health care providers at pilot sites:



1) Patients without a CD4 or VL submitted to Surveillance
within 30 days of initial diagnosis,
2) Patients with a gap of 120 days in receipt of CD4 or VL, and
3) Patients with a detectable VL
Sites report client status back to MDPH
Strategy 2 does not require consent

25
SPECTRuM Evaluation:
Local Goals and Measures
 Increase
proportion of newly dx’d linked to medical care
within 1 mo to 85% (baseline 60-75%)
 Increased proportion virally suppressed to 90%
(baseline=72%; 66-85% from sites’ baseline data)
 Increase proportion retained in medical care to 95% (≥ 2 HIV
medical visits in 12 mo, at least 3 mo apart, no gap >6 mo)
 Proportion with mental health issues, substance use, and/or
homelessness/housing instability referred for services, and
services received within 60 days
 Proportion identified by HIV Surveillance as disengaged,
who re-engage in clinical care within 1 month
26
Local Evaluation Plan - Strategy 1
 Assessment
"dose/response“ relationship of intervention
services (type of contact with nurse and peer) and
outcomes (retention and adherence measures)
 Client outcomes at pilot and expansion sites (all clients)
compared to those at matched comparison sites
 Client outcomes at pilot/expansion sites (all clients,
individual-level changes, within site) pre/post
SPECTRuM
 Client outcomes at pilot/expansion sites between
SPECTRuM and non-SPECTRuM clients to compare
client experience within the same site
27
27
Local Evaluation Plan
Strategy 2
Individual
outcomes among those identified as
being out of care, based on Surveillance data
Client
outcomes among pilot/expansion sites
compared to matched comparison sites;
system attributes
Qualitative
analyses via interviews with clinic
staff regarding the usefulness of system
28
28
Multi-site Evaluation
 Quantitative:
Measures being finalized by
UCSF (ETAC)
Seven
key indicators for monitoring HHSfunded HIV prevention, treatment, and care
services
 Qualitative:

interviews with select MDPH and pilot site
staff,
 patient interviews
29
29
Accomplishments to Date
Health Department




Increased connection between HIV Surveillance
and Office of HIV/AIDS
Epidemiologic analysis of Electronic Laboratory
Reporting (ELR) data
Surveillance-Program feedback loop established,
yet to be formally evaluated for impact
HIV Prevention and HIV Care contract
management staff monitoring implementation of
direct service model (across CDC and HRSA
frameworks)
30
Accomplishments
Program Level

BMC:


Established nurse/peer model
Coordination between CTR and ID clinic
Streamlined intake and acuity screen

HHC:


Established nurse/peer model
Routine for running reports and contacting clients

UMass:

Established nurse/peer model
Coordination with ED, primary care, inpatient units
Communication with clients before first appointments



31
Current Activities and Plans
 Fine
tune acuity-based
assessment/reassessment tools
 Evaluate and improve the SurveillanceProgram Feedback Loop
 Strengthen provider networks across HIV
testing and care, in medical and non-medical
venues, to support effective linkage
 Explore 3rd party reimbursement opportunities
for linkage services
 Disseminate best practices
 Expand component strategies across
prevention and care programs
32
Panel Discussion
• Sophie Lewis
• Director of Service Development, Massachusetts DPH
Bureau of Infectious Disease
• Noelle Cocoros
• Director of Research and Evaluation, Massachusetts DPH
Bureau of Infectious Disease
• Gerald James
• Peer Navigator, Boston Medical Center SPECTRuM
• Abbe Muller
• Nurse, Boston Medical Center SPECTRuM
33
Peer Integration
What have been some of the
barriers to integration and how
did you overcome them?
Let us know your experiences in the chat room!
34
Lessons from the Field
What is the most important
lesson learned in forming these
partnerships; designing and
implementing the program?
Let us know your experiences in the chat room!
35
Partners in+care Resources
Visit Web / Open the Toolkit
www.incarecampaign.org - “Partners” tab
Sign up for Partners in+care Network
www.incarecampaign.org – “Partners” tab
Join Facebook
Send email to
[email protected] –
“Facebook” in subject line
36
Campaign Headquarters:
National Quality Center (NQC)
90 Church Street, 13th floor
New York, NY 10007
Phone 212-417-4730