• Percent of patients with visits in past 4 months
• Percent of patients on therapy (HAART: Highly Active Antiretroviral Therapy) for their HIV infection
• HIV Program mortality rates

National statistics indicate that many HIV treatment programs experience a greater than 30 percent lost-to-follow-up rate each year. Failure to retain patients in care compromises the individuals’ health status and has significant public health implications given that those outside of the care system are less likely to engage in safe practices.

The Christiana Care Health Services HIV Program, as a Ryan White Title III grantee, participated in an Institute for Healthcare Improvement Collaborative to improve clinical outcomes for patients infected with HIV utilizing the Chronic Care Model as a foundation for quality improvement strategies. By utilizing the Chronic Care Model, the HIV Program has developed a multi-disciplinary, patient-centered approach to care delivery in order to maintain the “care connection” between patients and their providers.

Changes include:

• Initiated visit reminder phone calls prior to scheduled appointments with demographic information verified and updated during these calls
• Initiated a “Positive Self-Management Program” to teach patients care strategies
• Enhanced the Peer Educator Program and staffed each clinical session with a peer educator
• Elicited Patient Advisory Committee input for program design
• Established onsite phlebotomy services
• Initiated Nurse Practitioner “fast track” for less complex patient visits to decrease total wait time at clinic visits
• Developed onsite specialty clinics: Renal, Internal Medicine, Hepatitis C Treatment, and Women’s Health to provide "one stop" care
• Designated Phone Nurse to improve efficiency in responding to patient requests
• Enhanced Medication Adherence Sessions with Clinical PharmD prior to treatment initiation and as needed throughout treatment

As a result of the changes, the following clinical outcomes were realized over a two-year period:

• 87 percent of patients are compliant with their visit schedule as defined by disease status
• 92 percent of patients are on HAART in keeping with disease status and current US Department of Health guidelines
• Mortality rate has decreased to 3 percent 

Lessons Learned:

• Assisting patients in self-management skills improves compliance and empowers patients
• Improved patient compliance (with visits and treatments) results in positive clinical outcomes
• Maintaining the “care connection” closes the gap in service delivery
• Providing multiple services under one roof results in patient satisfaction and improved compliance
• Integrated consumer participation (Peer Education and Patient Advisory Committee) creates an atmosphere of teamwork between the patient and the provider
• A multi-disciplinary (MD, RN, PharmD, Social Worker, Peers), patient-centered approach to patient care improves patient satisfaction, clinical outcomes, productivity, and efficiency

Future Steps:

• Enhance outreach efforts to engage HIV-infected individuals earlier in their care
• Continue to seek opportunities for new initiatives for program development

Robin Bidwell
CQI Coordinator
Christiana Care Health Services
HIV Program—Wilmington Annex
1400 Washington Street
Wilmington, Delaware 19801 USA

Phone: (302) 255-1307
rbidwell@christianacare.org