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)

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. The Project:

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.

Methods• Quasi-experimental interrupted time series design• O1 X O2• Independent variable: attendance at quarterly appointment,

completed quarterly lab work• Purposive sample of patients at high risk for loss-to-follow upSelection criteria included• No appointment made or kept in the last 3 months• No lab work done in the last 3 months• Poor medication adherence – some identified through pharmacy

verification• Patients identified by Team as high risk for adherence to care due

to past behaviorMethods• Sample size of 30 selected based on existing size of “hot list”• Additional 10 patients added due to poor initial responseData Collection• Weekly collection of data including those who attended

appointments, lab work• Maintenance of process evaluation• Descriptive data of population including past history of

appointments and “no shows,” comorbidities, social habits• A letter sent to selected patients said “You must call us to

schedule your appointment before March 31, 2013, to be eligible for your gift card. That’s it, that’s all you have to do!”

• Mailed on February 15th, 2013• Creation and maintenance of a spreadsheet with participating

patients and their progress toward goals • Creation and maintenance of a log of clinical process evaluation

to be updated as needed by HIV team members to identify strengths and weaknesses related to the process of the project (i.e. patient comments and complaints, staff comments and complaints, logistic issues, etc.)

• Creation of a personalized card to be given to the patient along with their gift card incentive

Results: Retention rate in target population increased from 35% to 50% during project

10%

14%

34%

43%

Binghamton Primary Care HIV patient population

18-2930-3940-4950+

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

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

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

L-R: L. Natik, K. Dodge, N. Tucker, G. Immerman

64%

36%

Binghamton Primary Care HIV Patient Population

Male Female

1 20%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No Tobacco UseTobacco Use

BPC HIV Population BPC Pilot Patient Population

Axis Title

1 20%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No Drug UseDrug Use

BPC HIV Population BPC Pilot Patient Population

Axis Title

Before After0%

10%

20%

30%

40%

50%

60%

Pilot Population Retention Rate

Pilot Population Retention Rate

17%

20%

31%

31%

Binghamton Primary Care Patient Retention Pilot

Project

18-29

30-39

40-49

50+

43%

57%

Binghamton Primary Care Patient Retention Pilot

ProjectMale Female