The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64672

Peter Messeri, PhD¹, Angela A. Aidala, PhD², Maria Caban, MA², Stephanie C. Kim, MPH³, Daniel Schluter, PhD⁴, Randall Sell, ScD⁵, and Robert Sember⁵. (1) Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168 St, New York, NY 10032, (212) 305-1549, pam9@columbia.edu, (2) Center for Applied Public Health, Columbia University, 722 West 168th Street, Suite 1119, New York, NY 10032, (3) School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 West 168th Street, Suite 1120, New York, NY 10032, (4) Joseph L. Mailman School of Public Health, ETAC, Columbia University, 722 W. 168th Street, Room 1105, New York, NY 10032, (5) Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 West 168th Street, Suite 1119, New York, NY 10032

The 34 SPNS HIV service delivery demonstration grants funded from 1996 to 2001 shared a common theme of improving the quality of care through services integration models with a focus on the complications of caring for HIV+ clients associated with substance abuse, mental illness and/or unstable housing conditions. These grantees formed the Partnership Steering Committee ( PSC) to conduct multi-site evaluations. PSC grantees submitted locally collected data to a central coordinating center to form a multi-site database that included common core of client outcome and attribute measures. The multi-site data were used to investigate the effectiveness of two different services integration strategy on strengthening engagement in core HIV services. A client centered strategy was exemplified by various enhanced case management models, and a systems level strategy could take the form of either (1) formalized linkages between services delivered in different agencies or (2) co-location of different services within a single agency. Data from 17 PSC grantees were used to evaluate the association between these three strategies and cross-project variation in changes in engagement in medical care, mental health, drug treatment or housing services. Our data suggest that only case management was consistently associated with overtime increases in engagement in core services. However, confidence in conclusions about the effectiveness of case management or other services integration strategies was weakened by methodological challenges encountered in assembling the multi-site database. We summarized these challenges and discuss implications for future directions for evaluating services integration.

Learning Objectives:

At the end of this presentation the audience will:
• be able to identify key policy relevant distinctions in services integration strategies, 2)be able to identify primary causal pathways through which services integration strategies are hypothesized to improve quality of care, 3)have an understanding of possible directions for future research and program evaluation that will increase knowledge of effective models for integrating HIV services.

Keywords: HRSA, Service Delivery

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.