Online Program

Improving patient center medical home coordination in a safety net healthcare system among adults living with HIV

Tuesday, November 5, 2013 : 10:45 a.m. - 11:00 a.m.

John Schrom, MPH, Institute for Health Informatics, University of Minnesota, Minneapolis, MN
Scott Shimotsu, PhD MPH CPHQ, Hennepin County Medical Center, Minneapolis, MN
Sara Poplau, Hennepin County Medical Center, Minneapolis, MN
Kevin Larsen, MD, OCMO, Office of the National Coordinator of Health IT, Washington, DC
Background: While new care models, such as patient-centered medical homes (PCMH), are continuing to see increased adoption, Ryan White CARE Act-funded clinics have already been practicing such models for over a decade. This present study aims to examine the characteristics and PCMH case management utilization patterns in a safety net healthcare system of adults living with HIV. We hypothesize that social factors will be associated with case management utilization even after accounting for medical complexity.

Methods: Data were drawn from two sources: the electronic medical record and a social services database for 610 HIV-positive patients who received case management services during the measurement period (2008 - 2010). We measured case management utilization per month (minutes), medical complexity (adapted from the Johns Hopkins' ACG tool), and self-report demographic and socioeconomic variables (e.g., education, housing status). Adjusted linear regression models were used to test our study hypothesis.

Results: On average, patients received 141 minutes of case management services per month (range: 2-910 minutes/month). Medical complexity modestly predicted care coordination utilization. However, other Social and behavior variables provided a greater contribution to case management utilization, including: housing status (β=75.5; p < 0.0001), literacy (β=43.2; p < 0.05), and interpreter requirements (β=59.5; p < 0.0001).

Conclusions: Our findings suggest that future care models may need to incorporate social factors such as housing status, literacy and socioeconomic status. Future risk stratification tools may be further refined to impact care coordination for patients with HIV.

Learning Areas:

Administration, management, leadership
Public health or related public policy

Learning Objectives:
Differentiate social and medical characteristics and case management utilization patterns of adults living with HIV.

Keyword(s): HIV/AIDS, Case Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: After receiving my MPH, I worked as an epidemiologist for the largest HIV clinic in Minnesota and managed the HIV testing program for a drop-in youth center. Additionally, I have served on the MN HIV Services Planning Council, as well as chaired the Minneapolis Public Health Advisory Committee.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.