2012 Accomplishments for Positive Charge Initiative (PCI)

The North Carolina Positive Charge Initiative (PCI) at CHPIR is working with partners in three areas of the state representing the diversity of our communities, agencies, and populations. Teams of Access Coordinators (trained peers) with the Hertford County Public Health Authority, Partners In Caring, and the Mecklenburg County Health Department are conducting outreach in the community targeting those who are not engaged in the HIV service system.

In 2012, through these partnerships, PCI connected over 200 clients with HIV to Access Coordinators, who helped these clients participate in new and/or sustain existing HIV medical care. In each PCI region of the state three Access Coordinators lead HIV support groups, often providing the only HIV-specific support group in their respective region. Moreover, these Access Coordinators led and/or participated in multiple community HIV education and testing events, including events in rural Hertford and Elizabeth City, suburban Wilmington area and Charlotte. Attended by general community members, service providers, PLWHAs, educators, and elected officials, these successful even were made possible through PCI’s important partnerships with the NAACP, faith-based communities, and local health departments. In this process, Access Coordinators enhanced their presentation skills, ability to successfully work with clients, develop Self-Care Planning tools, in addition to learning modules for AC skills.

CHPIR’s staff promoted PCI’s work by creating a new website (www.accesstocarenc.org), which serves as hub for knowledge and community-based resources on HIV/AIDS with STD fact sheets and HIV Bingo to name two. Moreover, CHPIR’s efforts also produced in a detailed poster that compares the health outcomes among HIV-infected persons in both rural and urban settings in the southeastern USA following the implementation of access-to-care interventions, which featured at the 2012 International AIDs Conference. Additionally, Beth Stringfield, a CHPIR project coordinator, participated in a panel discussion entitled, “Strategies on the Ground to Turn the Tide on Improving Access to Care in the U.S”

Publications and Presentations

•  B. Stringfield, K. Walker, S.N. Tchwenko. “A rural-urban comparison of outcomes following implementation of an access to care initiative for HIV-infected persons in southeastern U.S.A.” Presented at 2012 International AIDS Conference in Washington, D.C. (July 2012).
• Beth Stringfield, CHPIR Program Coordinator, participated in a panel discussion on “Strategies on the Ground to Turn the Tide on Improving Access to Care in the U.S.” 2012 International AIDS Conference in Washington, D.C. (July 2012).

The Regional Health Information Integration Project (RHIIP) finished its final year of HRSA SPNS funding (completed on August 31, 2012), producing several remarkable achievements. RHIIP developed the Carolina HIV Information Cooperative (CHIC) Regional Health Information Organization (RHIO), which enabled data-sharing via CAREWare in the Ryan White Region 3 HIV Network of Care in North Carolina. The medical care for Region 3 is coordinated and provided by Wake Forest Baptist Health.  Client data is exchanged between Wake Forest and five AIDS service organizations in the Region. As of October 2012, the RHIO had grown to 43 users with 3835 clients and active data exchange was occurring within the network of care and the State AIDS Care Program.

In 2012, the core CHIPR team for RHIIP—Lynne Messer, Heather Parnell, Renee Huffaker, Darren Webber, Miriam Berger, and Casey Rubenstein—completed an evaluation of RHIIP’s activities based upon data collected through medical chart abstractions and other RHIIP data. These evaluation activities resulted in the production of one publication, as well as a total of six presentations on RHIIP’s work at a variety of venues, including the 140th Annual Meeting of the American Public Health Association, National Association of Social Workers 2012, and 5th Annual Society for Epidemiologic Research Meeting.

Publications and Presentations

• Messer LC., Parnell, H., Huffaker R., Wooldredge R, Wilkin A. The development of a health information exchange to enhance care and improve patient outcomes among HIV+ individuals in rural North Carolina, International Journal of Medical Informatics, Available online 13 August 2012, ISSN 1386-5056, 10.1016/j.ijmedinf.2012.07.009.
  • BACKGROUND: The Regional Health Information Integration Project (RHIIP) has developed the Carolina HIV Information Cooperative regional health information organization (CHIC RHIO). The CHIC RHIO was implemented to improve patient care and health outcomes by enhancing communication among geographically disconnected networks of HIV care providers in rural North Carolina. CHIC RHIO comprises one medical clinic and five AIDS Service Organizations (ASOs) serving clients in eight rural counties.
  • METHODS: Communication among the CHIC RHIO members is facilitated by CAREWare software. The RHIIP team assessed organizational readiness to change, facilitated relationship-building for CHIC RHIO, created the CHIC RHIO and used both qualitative and quantitative approaches to evaluate the process-related effects of implementing a data-sharing intervention.
  • RESULTS: We found the CHIC RHIO member organizations were ready to engage in the IT intervention prior to its implementation, which most likely contributed to its successful adoption. The qualitative findings indicate that CHIC RHIO members personally benefited – and perceived their clients benefited – from participation in the information exchange. The quantitative results echoed the qualitative findings; following the CHIC RHIO intervention, quality improvements were noted in the ASO and medical clinic relationships, information exchange, and perceived level of patient care. Furthermore, hopes for what data sharing would accomplish were overly high at the beginning of the project, thus requiring a recalibration of expectations as the project came to a close.
  • CONCLUSIONS: Innovative strategies for health information exchange can be implemented in rural communities to increase communication among providers. With this increased communication comes the potential for improved health outcomes and, in turn, healthier communities.
• Messer L.C., Parnell H., Sullivan K. “Regional Health Information Integration Project” Oral presentation at the 2012 Ryan White Grantee Meeting Washington, DC. November 27 – 29, 2012.
• Parnell H., Messer L.C., Huffaker R. “Development and utilization of a health information exchange to enhance communication between ancillary and medical HIV care providers in rural North Carolina.” Roundtable presentation at the 140th Annual Meeting of the American Public Health Association. San Francisco, CA. October 27-31 ,2012.
• Messer L.C., Parnell H., Tchwenko  S. “Trends in health outcomes for HIV patients in rural North Carolina following the implementation of a health information exchange to improve community based practice in HIV.” Poster presentation at the 140th Annual Meeting of the American Public Health Association Annual Meeting.  San Francisco, CA.  October 27-31, 2012.
• Messer, L.C. “ACASI results combined 2009 and 2010.” Presented at the final RHIIP CHIC RHIO meeting. Winston Salem, NC. August 22, 1012.
• Rubenstein C., Parnell H., Messer L.C., Wilkin A, Huffaker R. “Regional health information integration project: A new perspective on case management.” Poster presentation at the National Association of Social Workers 2012 Conference. Washington, DC. July 22-25, 2012.
• Tchwenko S., Parnell H., Messer L.C. “Health outcomes following a health information exchange intervention for HIV patients.” Poster Presentation at the 45th Annual Society for Epidemiologic Research Meeting. Minneapolis, MN. June 27-30, 2012.

In 2012, (NC-LINK) completed its first year and began its second year of four total years of funding from a HRSA Ryan White SPNS grant, as part of the Systems Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative.  The grant was administered to the NC DHHS Communicable Disease Branch, and is a partnership between the NC DHHS, Duke University and UNC Chapel Hill, with participation from two pilot intervention sites: Wake Forest University Health Sciences (WFUHS) and East Carolina University (ECU).

NC-LINK collected ongoing process data to test our intervention strategies and activities to link, retain and reengage people living with HIV/AIDS (PLWHA) in consistent care. This is being accomplished via a two-year Learning Collaborative and a corresponding Plan Do Study Act data collection that cycles with WFUHS, ECU and the NC DHHS study sites.  As part of the Learning Collaborative and an effort to have active participation from NC-LINK partners, the project hosted two successful two-day Learning Sessions in April and November, as well as a mid-point Webinar in July.

In addition, NC-LINK completed the baseline formative evaluation, which consisted of more than twenty stakeholder interviews with HIV clinical and ancillary care providers and state employees from around North Carolina with the goal of obtaining a complete picture of the HIV prevention and care system in North Carolina. Building on this research, CHPIR staff performed two oral presentations—the first at the UNC Symposium on HIV Care, and the second at the Ryan White SPNS Grantee Meeting.

Publications and Presentations

• Hosted NC-LINK Learning Session 1 for all project partners: April 11-12, 2012.
• Quinlivan EB, Messer LC, Clymore J. “NC-LINK Project: Testing, Linking and Keeping Patients in Care” Oral presentation at the UNC Symposium on HIV Care in 2012: Trends in Clinical Care and Caring for Vulnerable Populations. Chapel Hill, NC. May 7, 2012.
• Hosted NC-LINK Midpoint Webinar for all project partners: July 16, 2012.
• Klein E,  Quinlivan EB, Sullivan K, Parnell H. “NC-LINK Project” Oral presentation at the 2012 Ryan White SPNS Grantee Meeting Washington, DC. September 11-12, 2012.
• Hosted NC-LINK Learning Session 2 for all project partners: November 15-16, 2012.