The 130th Annual Meeting of APHA

Abstract #36434

Trang Quyen Nguyen, MPH, Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599-7435, (919) 684-8012, trang@email.unc.edu and Kathryn Whetten-Goldstein, PhD, MPH, Center for Health Policy, Law and Management, Duke University, Box 90253, 125 Old Chemistry Building, Durham, NC 27708.

Issues: In North Carolina, new HIV/AIDS cases are disproportionately higher among women, African-Americans and Hispanics. In the eastern half of NC, services are fragmented and people living with HIV have difficulty accessing comprehensive care due to poverty, stigma, and competing needs and comorbidities. Description: The North Carolina Services Integration Project (NC SIP) formed a sustainable and replicable integrated care delivery system (IDS) for geographically dispersed residents living with HIV. With support from state and federal governance, Agency Coordinators facilitated integration of medical, case management, substance abuse and mental health providers. Providers confidentially stored and shared information, with client permission, within a closed computer network created as part of NC SIP. Another database gave providers and clients access to local and state HIV resources. Lessons Learned: The NC SIP philosophy to include all provider voices in project development enabled integration and relationship-building. Coordinators and participants collaborated with each other, strengthening the IDS. Voluntary provider participation from over 150 providers, coordinating care for 7,000 HIV positive patients via automated clinical and case management databases, represented the efficiency and acceptance of the IDS. NC HIV Provider Survey results indicated that providers participating in the IDS had more knowledge of, referrals to and satisfaction with other providers in their region. The IDS provided information never before accessible in rural areas, created a standard of care and improved decision-making. Recommendations: NC SIP personalized multiple communication modes to the benefit of providers' and administrators' care coordination, skills and support system The IDS could be incorporated into other rural regions and poor countries.

Learning Objectives:

• Describe a model of integrated care delivery that addresses the unique obstacles faced in providing care across vast rural regions to HIV patients with competing needs and multiple comorbidities.
• Identify at least five modes of enhanced and personalized communication to improve care coordination across different care disciplines.
• List at least five quantitative and qualitative means of evaluating integrated care via patient-related outcomes and provider care-giving characteristics.

Keywords: Rural Health Care Delivery System, Information Technology

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.