Project HERO Patient Navigation Program Monthly Meeting January 20, 2016

Agenda Check-in Updates on Resource page Program Progress and Discussion Upcoming fidelity study – presented by Alison Karasz, PhD *title* Check Hep C Training & Materials Added Harm Reduction Coalition’s Quality Healthcare Is Your Right: A Guide for People Who Use Drugs – Getting Better Care Updated Intervention Workflow Database & Reporting Instructions Updated Database Instructions Living Program Documents & Forms Updated Patient Navigation Best Practices Additional Care Coordination Resources Updated Follow Up Strategies for Hard to Reach Patients 10-15 minutes Introductions should include name, site and location, and any updates on the status of the program. Thanks for calling in, everyone! Today we’ll review the progress of the program and discuss what the program data shows thus far, in addition to some questions and discussions we’ve had from individual sites. Alison Karasz, PhD, will be discussing the upcoming fidelity study. Before we get started, I’d like to remind you about the Resource page and let you know about some updates that are reflected there. The intervention Workflow now includes refusal to participate. There is a copy of the database which does not include the report query, if you haven’t started using the database yet. New instructions are available as well. The Patient Navigation Best Practices has been updated with recommendations from past TA discussions. Follow Up Strategies for Hard to Reach Patients now includes a link to the CDC’s National Prevention Information Network to help you find local organizations to help to meet patient needs. Additionally, we’ve added a new resource from Harm Reduction Coalition, Quality Healthcare is Your Right! Ask if anyone is having an issue viewing the Resource page? State there were some issues viewing it in Google Chrome over the last week, but there is not an issue in Internet Explorer. It can be viewed there for now.

Program Progress: Enrollment (October 1, 2016 – December 31, 2016) Enrolled in December Active Patients Hepatitis Education Project - Seattle Johns Hopkins University – Baltimore 1 Justice Resource Institute - Boston The Miriam Hospital - Providence 5 10 Montefiore Medical Center -Bronx 7 Shanti Project & San Francisco AIDS Foundation – San Francisco University of New Mexico - Albuquerque West Virginia University- Morgantown Total 8 19 I’ve confirmed with Paula McKinley that each site is projected to enroll approximately 63 patients into patient navigation by the end of the research study. This slide shows how all four enrolling sites are progressing along and how many patients have been randomized into patient navigation at this point. = database submitted = database NOT submitted

Program Progress: Care Cascade (October 1– December 31, 2016) *enrolling sites: CA, MD, NY, RI and WA* The care cascade measures are used as a guide to ensure patients complete these defined steps to complete medical evaluation and start treatment. Highlight: Patients appear to be moving quickly and seamlessly through the cascade of care. PNs, can you talk about what this process has been like for you and your patients?

Coordinating Medical Care & Referring Patients for Services Program Progress Coordinating Medical Care & Referring Patients for Services

Patient Navigation Service Level * One missing* Do any patients have questions comments on assessing or reassessing patients’ service level?

Assessment & Referral: Mental Health

Assessment & Referral: Alcohol Use

Assessment & Referral: Drug Use For the purpose of this study, all of the participants should be initially marked as having used within the last year or having used ever in the Database. Drug use included injection and intranasal in the past year. Injection ever and/or in a substance use treatment program also included.

Assessment & Referral: Housing, Transportation & Referrals

Average Care Coordination Services Per Patient by Site Accompaniment Reminders Alcohol/ Drug Counseling Treatment Adherence Support Medication/ Pharmacy Coordination Case Conference Other Meeting with Patient Baltimore 1 Bronx 2 4 10 Providence 3 8 San Francisco Ask for a clarification on what they’re defining as accompaniment. Ask for clarification on whether reporting medical care information from provider report is an issue. Participants are receiving a significant amount of services, some sites are providing more of a particular service than others. For example, Providence is providing more treatment adherence support on average; whereas the Bronx is providing completing more case conferencing on average; and San Francisco is providing more accompaniment on average. Treatment adherence support is to be completed at least weekly while patients are on treatment. Ellie, do you have any comments or recommendations about providing treatment adherence support? Case conference should be completed at least monthly as this is where the PN is to be getting the medical information about clients. Yajaira, Tatiana or Kiara, do you have any comments or recommendations about case conferencing? Jordan or Pauli, do you have any comments or recommendations about providing accompaniment?

Patient Navigation Service Level REVIEW Patient Navigation Service Level After completing the Assessment, indicate a service level to the patient based on support needed: Low intensity: Need four minimum Patient Navigation encounters Need few reminders, can attend visits independently, and minimal support in accessing referrals, or getting through HCV medical evaluation and treatment Have a history of adherence to medications May be at low risk for HCV reinfection after treatment High intensity: Need more than four Patient Navigation encounters Need multiple reminders, and regular accompaniment, or support in accessing supportive referrals, or getting through medical evaluation or treatment Struggles adhering to medications as prescribed May be at high risk for HCV reinfection after treatment. (3 min) As a reminder, if you find that the needs of a patient are higher or lower than what you expected based on your initial assessment, you can change the intensity level to reflect your level of service to a patient.

Data & Reporting Clarifications Obtaining Hepatitis C Medical Evaluation Data Ask the patient navigators how they are collecting this information. Ask if this has been an issue or if it has been difficult to collect. Kim Fuller from the JHU team reminded me that there is one Case Notes section that is shared between the enrollment, assessment, care coordination, medical care and discharge/transition tabs. The Access database settings should allow you to fill this with several pages worth of text; however, to keep your notes organized and easy to page through, I’d recommend using the names of each tab as a heading for relevant notes as pictured.

Data & Reporting Clarifications Case Notes in the Access Database

Data & Reporting Clarifications Preparing a de-identified monthly report: Create a copy of your master database and save it as: HERO_StateInitials_Month_Date_Year, example HERO_PRI_7-5-16           Go to  menu and click on to pull your participant data into a table view. Go through the table and delete the following columns: patient last name, patient first name, date of birth, address, and zip code. A. To delete, right click the variable’s name and selecting “Delete field” or “Delete” in the Home tab. Once these variables have been deleted, save the database again. Note:  Do not use the query “Report PCORI Check Hep C.” A new copy of Database Instructions is saved on the Resources page under the heading Database & Reporting Instructions. Ask the patient navigators how they are collecting this information. Ask if this has been an issue or if it has been difficult to collect. 1min Required trainings are printed in agenda, pull these up before meeting: Check Hep C online training (for all). All modules can be completed in 2 hours at once or throughout the week. (Best viewed in Google Chrome. Go to: hepfree.nyc/check-hep-c-online-training and enter password: projecthero) Viral Hepatitis 101 offered at the NYC Health Department, OR confirm completion of equivalent Hepatitis C basics training at the NYC Health Department, NYS AIDS Institute or your organization. (Go to: bit.ly/ttapnyc) “Online Learning: Overview of Motivational Interviewing” offered online at NYS AIDS Institute www.hivtrainingny.org (Go to: bit.ly/aidsinstitute) Measures are used as a guide to ensure patients complete these defined steps to complete medical evaluation and start treatment.

Upcoming Resources Upcoming Webinars: HepCure, Tuesdays from 4:30 -5:30 p.m. EST January 24th EST Dr. Norah Terrault – Pregnancy & Hepatitis C January 31st, Dr. David Wolf – HCC in the Context of HCV February 14th, Dr. David Dayan-Rosenman – Hepatitis C Treatment in the Active Substance User Harm Reduction Coalition February 23rd, 1-3 p.m. Mike Selick & Joanna Berton Martinez - Hepatitis C Basics

Contact Us Let us know if you have questions or concerns, or need help with any aspect of the program. Early identification is the key to prevention! ☺ Angie Woody Program Assistant awoody@health.nyc.gov Nirah Johnson, LMSW, Director of Capacity Building and Program Implementation njohnso2@health.nyc.gov