Using Existing Datasets for Using Existing Datasets for Local Evaluation Studies Local Evaluation Studies

of the CARE Actof the CARE Act

Computerized Networking of HIV

Providers Workshop May 8, 2003

Local Evaluation Studies

Competitions initiated in FY 1997 Open to CARE Act grantees and providers Focused topics RFQs submitted, reviewers selected Applicants had to have 2 years’ existing

data Several study topics are shown in the

following slides

Ancillary Services Studies

Question: is receipt of CARE Act-funded ancillary/support services associated with clients’ entry into and retention in primary care?

These services account for about 1/3 of Title I, II discretionary spending– We track this on the basis of annual allocation data

submitted with grant applications– Now submitted in standard spreadsheet format

Eight sites participated, seven with cross-sectional clinical data and one with time-series client interviews

Study Findings Most sites found associations between

ancillary service receipt and primary care entry, retention– Case management, mental health and

substance abuse treatment, transportation, housing and nutrition assistance, etc.

Causal inferences difficult– Time-series data found lagged effects

August 2002 supplement to AIDS Care Led to conceptual development on

characteristics of systems of care

Impact of Services on Outcomes Most studies have focused on

– Access to care– Reductions in morbidity, mortality among

CARE Act clients

Findings– Earlier studies showed lesser HAART access

by uninsured clients– Later studies show comparable access,

outcomes for CARE Act & insured clients– But they reveal other persistent disparities

Quality Initiative ‘Haves’ were funded, ‘have-nots’ were not Change in focus toward evaluation TA

– New emphasis in 2000 reauthorization of CARE Act on CQI

– Grantees asked to propose evaluations leading to CQI Topics being examined

– are patients receiving appropriate HAART, prophylactic meds, immunizations, and lab tests?

– are there disparities among population subgroups in receipt of these services?

– are patients being adherent with their medication regimens?

– has receipt of these services reduced disease progression, as measured by CD4, VL?

HIV Research Network

To track HIV patients’ resource use on a ‘real time’ basis– Funded by HRSA, AHRQ, SAMHSA, NIH– 18 sites, about 15,000 patients– Submit standard data elements every 6 mo.– 1999 pilot study findings published in JAIDS,

6/2002, similar to HCSUS

Data are primarily from medical records

HIVRN Interviews From clinical data cannot track services clients

receive elsewhere An interview is being conducted with a subset of

clients at nearly all sites, asking about– primary care services that clients may have sought

from other institutions– support services, such as case management and mental

health treatment, including those not provided onsite– medications that clients are taking

• some sites do not have good records on medications

• others indicate only prescriptions that were written but do not track which prescriptions were filled.

Integrated data systems could answer this need

Growing Focus on Disparities

Outcome studies reveal disparities in access– associated with race/ethnicity, gender, risk

factor, age, and insurance status

Planning studies to address disparities– Open to sites able to document them– Goals are to improve

• Providers’ skills for client-centered care

• Clients’ sense of empowerment to become more active participants in their care plans

CARE System Assessment

Just launched demonstration project– Using RARE techniques to identify barriers to

care among marginalized populations– Assessment of systems of care to see how their

organization contributes to barriers– Intent to transform planning process

One component of system integration is the integration of computerized data sets– CDP allowed us to compare service seeking

patterns in different racial/ethnic groups