Short
Summary of Major Cross-Cutting Evaluation Findings
from HRSA/HAB's Cooperative Agreements on
Innovative Models of Care
Frequently
Updated and Supplemented
Last Updated:
November 13, 2009
The Measurement Group
G. J. Huba, Ph.D.
Lisa A. Melchior, Ph.D.
A. T. Panter, Ph.D.
Supporting data and statistical models are given in the
full Knowledge Base. Access the full Knowledge Base by clicking on the buttons
at the end of this page or the "light blue" portion of the banner at
the top of the page. To see the full Knowledge Item from which a summary point
derives, click on the figure.
Click on the links below to navigate the major summary points derived from
the HIV/AIDS Knowledge Base.
Client
Service Need, Vulnerability, and Demographic Factors
Summary Point 1: Access to services has been provided to more than 4,800 individuals living with HIV/AIDS. The
treatment populations for both medical services and psychosocial supports is heavily skewed toward individuals with a number of service needs-vulnerabilities (an average of
6.94 such factors out of 15 coded).
-
6.0% were under age 21
or over age 55;
-
72.5% were people of
color;
-
11.9% had a
primary language other than English;
-
20.0% had children requiring
care;
-
45.3% had an education of less than 12
years;
-
85.7% were
unemployed or not
working;
-
88.9% were dependent on public support for medical
insurance (no private insurance);
-
28.2% used or had used
heroin;
-
44.9% used or had used
crack;
-
56.9%
used or had used another illicit drug;
-
54.2% had a current or prior
alcohol problem;
-
49.7% were or had been involved with the criminal
justice system;
-
22.1% engaged in current or prior sex work;
-
42.9% engaged
in current or prior sex with an injection drug user;
-
46.4%
were without stable housing.
At the time of enrollment, the participants who entered these programs report a number of prior unmet service needs and previously experienced barriers to care.
Distribution of the
Total Number of Service Needs - Vulnerabilities for Males and Females
with HIV/AIDS Enrolling in the Cooperative Agreement Projects
Change in Medical
Indicators Over Time
Summary Point 2: Patients in SPNS treatment programs were offered (and received) recommended medical treatments including HAART when it was available. Statistical [HLM] models show that the health of patients improves significantly over time as assessed with CD4 count and viral load tests. The degree of change is only very minimally related to factors indicative of behavioral issues such as drug abuse, sex work, and unstable housing.
Additional analyses examine the role, timing, pharmaceutical variations of HAART treatment within the episode and the interactions of HAART treatment and behavioral factors that may limit adherence to medical recommendations.
Change Over Time in
Self-Rated Quality of Life
Summary Point 3: Patients in the SPNS treatment programs report significantly improved health-related quality of life over the course of their treatment episode. Statistical [HLM] models show that on average self-reported quality of life improves significantly over time, and that such gains may be maintained for periods of several years. While all programs in aggregate help their patients improve and maintain quality of life, the degree of positive change is substantially related to the presence of wrap-around psychosocial services, with preliminary results suggesting approximately a 30% incremental improvement in self-reported quality of life for those programs with intensive integrated psychosocial (or "wrap-around") services.
Additional analyses examine the patterns of wrap-around services that most influence changes in quality of life.
Days Retained in Program by Needs and Drug
Abuse
Summary Point 4: Clients in the programs offering psychosocial supports for HIV care tend to have an average of more than five major service vulnerabilities including unstable housing, drug abuse, criminal justice involvement, unemployment, and racial or linguistic barriers to treatment. In spite of high need-vulnerability levels, the clients have voluntarily remained in the psychosocial support programs for, on average, several years. Relatively high-need participants are retained in the SPNS service demonstration models for about as long as lower-need participants.
Retention in Psychosocial Services Based on
Case Management
Summary Point 5: Clients in the programs offering psychosocial supports for HIV care tend to have an average of more than five major service vulnerabilities including unstable housing, drug abuse, criminal justice involvement, unemployment, and racial or linguistic barriers to treatment. In spite of high need-vulnerability levels, the clients have voluntarily remained in the psychosocial support programs for, on average, several years. Relatively high-need participants are retained in the SPNS service demonstration models for about as long as lower-need participants. Clients with one or more sessions of active case management have about half the likelihood of leaving the program. Psychosocial service providers have also been able to help their clients avoid increasing feelings of depression or hopelessness about their illness.
Client Satisfaction Based
on Type of Project
Summary Point 6: The medical and psychosocial service demonstration models developed have been almost uniformly rated by their participants as "very good" or "excellent" and responsive to participant needs. The level of program satisfaction is not systematically related to behavioral issues or service needs-vulnerabilities, suggesting that the programs are able provide equally satisfactory services for very high need patients with such issues as drug abuse, participation in sex work, criminal justice system involvement, and membership in groups that have traditionally under-accessed services. In addition to overall satisfaction, patients note that they are treated with respect, staff communicate effectively with them, and that they would recommend that their friends access services at the provider. Satisfaction is slightly higher in the programs–Community Based Organization Psychosocial Services, University Comprehensive
Healthcare–with wrap-around psychosocial support services or Integrated Care
Models as opposed to the Managed HIV/AIDS Care Models.
Results of Follow Up Training
Interviews
Summary Point 7: Between 1994 and 1999, the SPNS Cooperative Agreement Projects provided training to almost 10,000 healthcare and related professionals on medical and psychosocial treatment issues in HIV/AIDS care, sensitivity to the needs of special populations, and special technical topics in AIDS care. Six-to-twelve month follow-up interviews with several hundred healthcare professionals who had attended trainings at one of nine projects found that
79% of the respondents said the training had a positive effect on how they provided services to their patients or clients;
82% of the trainees mentioned at least one specific and concrete instance of change in patient care in their program as a direct result of the training
experience. As context, the individuals interviewed had had an average of 5.9 years experience working with HIV/AIDS patients, and hence the trainings raised skills and the awareness of new treatment issues significantly among even an experienced group of professionals.
Mean Rating of How
Training Affected...
Percent Indicating Training had
Positive Effect on...
Introduction of Triple Combination Therapy
Summary Point 8: Triple combination
therapies including protease inhibitors became widely available during the
course of these projects. Approximately half of the patients on whom
pharmaceutical data are available received triple combination therapy. Access to
triple combination therapy or HAART (highly active antiretroviral therapy) was
made to patients irrespective of major demographic and behavioral categories,
with the exception of active heroin use (active heroin users were much less
likely to receive triple combination therapy). The same rates of triple
combination therapy usage were found in Managed Care and University
Comprehensive Healthcare (Integrated Care) projects, for men and women, and for
racial-ethnic groups.
Triple Combination Therapy and Change in
Medical Indicators Over Time
Summary Point 9: Triple combination
therapies including protease inhibitors became widely available during the
course of these projects. Approximately half of the patients on whom
pharmaceutical data are available received triple combination therapy. Patients
who received triple combination therapies had a more pronounced rise in CD4
counts and a sharper decrease in viral loads than did patients who were not
known to have received these therapies.
Likelihood of
Receiving Services by Time in Program
Summary Point 10: In aggregate,
the psychosocial service providers (community based organizations) and
providers of integrated medical (and psychosocial) care, have defined
a continuum of services that are required for high need individuals
who are brought into psychosocial care which supports their medical
care. While there are many site-specific variations dependent upon the
target population for the project, the overall mission of the agency,
and the type of staff employed by the agency, in aggregate the
likelihood that various services are required has been defined by
these projects. The following charts are fitted statistical curves
that show the likelihood that a client will be provided each of seven
major types of services by psychosocial service providers and
integrated medical care providers as a function of how long the client
is in the program. As can be seen, these projects have defined a
continuum of care, for an aggregate group of high-need persons living
with HIV, in which case management is a necessity; individual and
group counseling are highly likely to be needed (and provided) and
other services such as counseling to prevent HIV re-transmission and
secondary infection are also likely to be needed.
Estimated ("Fitted") Probability
of Having Received HIV Prevention/Intervention Services
for Participants at Medical and Psychosocial Service Providers as a
Function of Days in the Program: Separately by Gender
Estimated ("Fitted") Probability
of Having Received Individual Counseling Services
for Participants at Medical and Psychosocial Service Providers as a Function of
Days in the Program: Separately by Gender
Estimated ("Fitted") Probability
of Having Received Psychiatric/Psychosocial Assessments
for Participants at Medical and Psychosocial Service Providers as a
Function of Days in the Program: Separately by Gender
Estimated ("Fitted") Probability
of Having Received Group
(not Couple) Counseling for Participants at Medical and Psychosocial Service Providers
as a Function of Days
in the Program: Separately by Gender
Estimated ("Fitted") Probability
of Having Received Family/Couple Counseling
for Participants at Medical and Psychosocial Service Providers as a Function of Days
in the Program: Separately by Gender
Estimated ("Fitted") Probability
of Having Received Substance Abuse Services
for Participants at Medical and Psychosocial Service Providers as a Function of Days
in the Program: Separately by Gender
Estimated ("Fitted") Probability
of Having Received Case
Management Services for Participants at Medical and Psychosocial Service Providers
as a Function of Days in
the Program: Separately by Gender
Change in Self-Rated
Quality of Life by Satisfaction with Services
Summary Point
11: Patients who have relatively the most improvement in their quality of
life and whose clinicians rate their progress as most improving (or
least deteriorating) rate the quality of their programs most highly.
Over samples of hundreds of patients, those who had the most change in
their self-rated ability to work, enjoy life, and be relatively
unaffected by their symptoms were those who were also rated the quality
of their programs most highly. It was also true that those patients who
clinician rated their functioning as better, or at least stabilized,
also rated their programs as of higher quality. The patient ratings of
program quality are related to the actual progress of the patient in the
programs.
Relationship Between
Estimated Change in Quality of Life Over Time (from a Hierarchical
Linear Model) and Patient Judgment About Quality of Services
(statistically significant relationship; patients who improve most say
their program has the highest quality)
Relationship Between
Estimated Change in Clinical Karnofsky Severity Rating (from a
Hierarchical Linear Model) and Patient Judgment About Quality of
Services (statistically significant relationship; patients judged by the
clinician to improve most say their program has the highest quality)
The following charts show the
percentage of individuals rating the services as fair/poor, good, very
good, or excellent who improved.
Quality
of Life
Karnofsky
Severity Rating
Training Quality Ratings
Summary Point 12: Between 1994 and 1999, the SPNS Cooperative Agreement Projects provided training to almost 10,000 healthcare and related professionals on medical and psychosocial treatment issues in HIV/AIDS care, sensitivity to the needs of special populations, and special technical topics in AIDS care.
As shown for 604 trainings below, the average rating of quality for
the trainings, on a scale from 1-to-5 was very high.
Change Over Time in Client Distress
Summary Point 13: Clients in the SPNS treatment programs report significantly
decreased levels of psychological distress over the course of their treatment episode. Statistical [HLM] models show that on average self-reported
psychological distress decreases significantly over time, and that such gains may be maintained for periods of several years.
Change in Client Barriers Over Time
Summary Point 14: Clients in the SPNS treatment programs report significantly
decreased levels of perceived barriers to receiving needed care over the course of their treatment episode. Statistical [HLM] models show that on average self-reported
perceived barriers to service levels decrease significantly over time, and that such gains may be maintained for periods of several years.
Change Over Time in
Self-Reported Symptoms
Summary Point
15: Patients in the SPNS treatment programs report significantly
decreased levels of self-reported symptoms over the course of their treatment episode. Statistical [HLM] models show that on average self-reported
symptom levels decrease significantly over time, and that such gains may be maintained for periods of several years. It
is important to note that the changes are self-reported ones.
Probability of Retaining CD4
Count by Type of Clinic
Summary Point
16: More than half of the patients, with the progressive disease of HIV/AIDS, may be maintained at the same
or higher CD4 count for a period of time approaching the maximum
in our evaluation study, of about three years. Patients in the
Comprehensive Medical Care Programs are the most likely to be maintained.
Probability of Maintaining
Karnofsky Rating by Type of Clinic
Summary Point
17: Most patients, with the progressive disease of HIV/AIDS, may be maintained at the same
or higher level of functioning for a period of time approaching the maximum
in our evaluation study, of about three years. Patients in the
Comprehensive Medical Care are the most likely to be maintained.
Probability of Maintaining
Viral Load at or Below Baseline
Summary Point
18: More than half of the patients, with the progressive disease of HIV/AIDS, may be maintained at the same
or lower viral load levels for a period of time approaching the maximum
in our evaluation study, of about three years. Patients in the both the
Managed Medical Care and Comprehensive Medical Care Programs were
about equally likely to be maintained for a given period of time.
Probability of Same or Improved
Psychological Distress Level
Summary Point
19: More than half of the clients, with the progressive disease of HIV/AIDS, may be maintained at the same
or higher level of psychological functioning for a period of time approaching the maximum
in our evaluation study, of about three years.
Medical and Psychosocial
Outcomes by Gender
Summary Point
20: On most major indicators of outcomes, male and female
patients had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[by Gender]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Race-Ethnicity
Summary Point
21: On most major indicators of outcomes, patients from different
ethnic-racial groups had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Race-Ethnicity]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Sexual Orientation
Summary Point
22: On most major indicators of outcomes,
patients with differing sexual orientations had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Sexual Orientation]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Site Type
Summary Point
23: On most major indicators of outcomes,
patients from psychosocial and medical projects had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Site Type]
[Note:
Psychosocial Projects did not collect medical indicators.]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Drug Abuse
Summary Point
24: On most major indicators of outcomes,
patients non-users of drugs and drug abusers had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[by Drug Abuse Status]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Housing Status
Summary Point
25: On most major indicators of outcomes,
patients with differing degrees of housing stability had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[By Housing Status]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Age
Summary Point
26: Non-chance levels of positive outcomes are achieved for the
groups of patients aged 21-55 and over 55 years; the fact that the levels are
not significantly above chance for the younger group may be more a function of
sample size than a lack of positive outcomes.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Age]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Primary Language
Summary Point
27: On most major indicators of outcomes, patients with a primary
language of English or not-English had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Primary Language]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Childcare Needs
Summary Point
28: On most major indicators of outcomes, patients with differing
degrees of childcare needs had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Childcare Needs]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Highest Grade Completed
Summary Point
29: On most major indicators of outcomes, patients with differing
levels of education had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Highest Grade Completed]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Employment Status
Summary Point
30: On most major indicators of outcomes, patients with differing
levels of employment had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Employment Status]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Insurance Coverage
Summary Point
31: On most major indicators of outcomes, patients with differing
types of insurance had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Insurance Coverage]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Alcohol Problem
Summary Point
32: On most major indicators of outcomes, patients who did, or
did not abuse alcohol, had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Alcohol Problem]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Heroin Use
Summary Point
33: On most major indicators of outcomes, patients who did, or
did not abuse heroin, had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Heroin Use]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Crack
Summary Point
34: On most major indicators of outcomes, patients who did, or
did not abuse crack had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Crack Use]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Other Drug Use
Summary Point
35: On most major indicators of outcomes,
patients who did, or did not abuse other drugs had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Other Drug Use]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Criminal Justice System Involvement
Summary Point
36: On most major indicators of outcomes,
patients with differing patterns of criminal justice involvement had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Criminal Justice System Involvement]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Sex Work
Summary Point
37: On most major indicators of outcomes,
patients actively in sex work had lower levels of positive outcomes; for
individuals actively engaging in sex work, the degree of positive
outcomes is significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Sex Work]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Sex with Injection Drug User
Summary Point
38: On most major indicators of outcomes, patients who
were, or were not sex partners of injection drug users had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Sex with Injection Drug User]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Dependent Upon Public Supported Medical Services
Summary Point
39: On most major indicators of outcomes,
patients who were, and were not dependent on the public medical system had similar levels of positive outcomes, with the degree of positive
outcomes significantly above chance levels.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Dependent Upon Public Supported Medical Services]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Medical and Psychosocial
Outcomes by Type of Project
Summary Point
40: Overall, the Psychosocial Projects obtained non-chance
levels of positive psychosocial outcomes while the medical projects did not do
so; for all medical indicators, the medical projects in aggregate achieved
non-chance levels of positive outcomes.
Positive Outcomes: Maintained or
Enhanced Functioning Over Time in Program
[Type of Project]
The number of patients
in each group varies by outcome and may be quite small in some cases. Click on the graphic for the original Knowledge Item to
see the number of patients in each category and formal statistical tests that the probability of a positive outcome exceeds chance level
(50%). The original Knowledge Item also includes tests of whether the successful outcome rates for each group on each indicator are statistically different from one another.
Patient-Rated Satisfaction
with Services by Gender
Summary Point 41:
Splitting the
overall sample by gender, it was found that for both males and females,
significantly more patients rated the program as very good or excellent
than would be expected by chance. There was no difference in rated
program quality by gender of the patients.
Patient-Rated
Satisfaction with Services by Race-Ethnicity
Summary Point 42:
Splitting the
overall sample by race-ethnicity, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. African-American patients rated the
programs as having a slightly lower quality.
Patient-Rated
Satisfaction with Services by Sexual Orientation
Summary Point 43:
Splitting the
overall sample by sexual orientation, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. All sexual orientation groups rated
the programs with about the same overall quality level.
Click
graphic to expand.
Patient-Rated Satisfaction
with Services by Type of Clinic
Summary Point 44:
Splitting the
overall sample by type of clinic, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. The University Comprehensive
Healthcare (Integrated Care) and Community Based Organization projects were
rated as higher in quality by their clients.
Patient-Rated
Satisfaction with Services by Drug Abuse
Summary Point 45:
Splitting the
overall sample by drug abuse, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Prior users of drugs tended to rate
the programs as having slightly lower quality than did either individuals for
whom drug use was not identified or for whom there was current drug use.
Patient-Rated
Satisfaction with Services by Housing Status
Summary Point 46:
Splitting the
overall sample by housing status, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Individuals with unstable housing
tended to rate the programs as being of somewhat higher quality.
Patient-Rated Satisfaction
with Services by Age
Summary Point 47:
Splitting the
overall sample by age, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. There was no difference in rated
program quality by the age of the clients.
Patient-Rated
Satisfaction with Services by Primary Language
Summary Point 48:
Splitting the
overall sample by primary language, it was found that for both groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. There was no difference in rated
quality by the primary language of the program participants.
Patient-Rated Satisfaction
with Services by Childcare Needs
Summary Point 49:
Splitting the
overall sample by childcare needs, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. There was no difference in rated
program quality by whether the client needed childcare while in services.
Patient-Rated Satisfaction
with Services by Highest Grade Completed
Summary Point 50:
Splitting the
overall sample by highest grade completed, it was found that for all
groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Program satisfaction levels were not
related to the highest grade level completed.
Patient-Rated Satisfaction
with Services by Employment Status
Summary Point 51:
Splitting the
overall sample by employment status, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Program satisfaction was not related
to the employment status of the patient.
Patient-Rated Satisfaction
with Services by Insurance Coverage
Summary Point 52:
Splitting the
overall sample by insurance coverage, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Program satisfaction was related to
whether the patient had public insurance; patients without insurance (or with
private insurance) rated the programs as higher in quality than did patients
with publicly-supported insurance.
Patient-Rated
Satisfaction with Services by Alcohol Problem
Summary Point 53:
Splitting the
overall sample by alcohol abuse status, it was found that for all
groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Status as having an alcohol problem
was not related to the degree of program satisfaction.
Patient-Rated Satisfaction
with Services by Heroin Use
Summary Point 54:
Splitting the
overall sample by heroin use, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Current and past heroin abusers had
somewhat lower levels of program satisfaction.
Patient-Rated
Satisfaction with Services by Crack Use
Summary Point 55:
Splitting the
overall sample by crack use, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Program satisfaction was not related
to status as a crack user or not.
Patient-Rated Satisfaction
with Services by Other Drug Use
Summary Point 56:
Splitting the
overall sample by other drug use, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Patients who had not abused
"other" drugs had slightly higher levels of program satisfaction.
Patient-Rated
Satisfaction with Services by Criminal Justice System Involvement
Summary Point 57:
Splitting the
overall sample by criminal justice system involvement, it was found that for
all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Patients with prior Criminal Justice
System involvement had the lowest levels of rated program satisfaction while
patients with current CJS involvement had the highest levels of rated program
satisfaction.
Patient-Rated
Satisfaction with Services by Sex Work
Summary Point 58:
Splitting the
overall sample by sex work, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Program satisfaction levels were not
related to status as a sex worker.
Patient-Rated Satisfaction
with Services by Sex with Injection Drug User
Summary Point 59:
Splitting the
overall sample by sex with injection drug user, it was found that for
all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Patients who had formerly been
involved with injection drug users had the lowest rated levels of program
satisfaction.
Patient-Rated
Satisfaction with Services by Dependent Upon Public Supported Medical Services
Summary Point 60:
Splitting the
overall sample by whether dependent on public supported
medical services, it was found that for all groups,
significantly more patients rated the program as very good or excellent
than would be expected by chance. Status as dependent or not upon the
publicly-supported medical system was not related to the degree of rated program
satisfaction.
These conclusions are solely
those of the authors and do not necessarily represent official conclusions of
HRSA or HRSA/HAB's Special Projects of National Significance. Analyses are
ongoing, and as new analyses are conducted, some of these summary points may
change.
George J. Huba, Ph.D.
Lisa A. Melchior, Ph.D.
Abigail T. Panter, Ph.D.
November 13, 2009
Suggested Citation:
Huba, G. J., Melchior, L. A., Panter, A. T., and the HRSA/HAB SPNS Cooperative Agreement Steering Committee (1998-2001).
Short Summary of Major Cross-Cutting Evaluation Findings from
HRSA/HAB's SPNS Cooperative Agreements on Innovative Models of Care, The Measurement Group Knowledge Base on HIV/AIDS Care, Online at
www.TheMeasurementGroup.com.
Note: Knowledge Items which
support the major Summary Points can be reached by clicking on the
figures.
Access the entire
Knowledge Base from
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Patient Outcomes from the Evaluation
of the HRSA/HAB/SPNS Cooperative Agreement Projects on Innovative Models
of HIV/AIDS Care
This presentation
summarizes medical and psychosocial outcomes from the 27 Cooperative Agreement Projects
funded by the Health Resources and Services Administration [HRSA],
HIV/AIDS Bureau [HAB] as Special Projects of National Significance [SPNS]
from 1994-1999. Featured are trend and maximum outcomes on measures of
patient functioning, including medical (CD4 Count, Karnofsky Severity
Rating, and Viral Load) and psychosocial (patient-rated Quality of Life,
Symptom Severity, Service Barriers, and Distress Level) indicators.
Retention and patient-rated service quality outcomes - disaggregated by
service need, vulnerability, and demographic factors - are also included
in this presentation.
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Findings from 27 Cooperative Agreement
Projects funded by the Health Resources and Services Administration
(HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance
(SPNS) from
1994-1999. Cross-cutting (multisite) evaluation and Knowledge Base by The
Measurement Group. The Evaluation and Dissemination Center was funded from
1994-2001.
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generated through program evaluation and applied research."
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Acknowledgments
Knowledge Base Citation: The Knowledge Base
was designed and authored by G.
J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L.
A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On
the World Wide Web: http://www.TheMeasurementGroup.com."
This
Knowledge Base has been authored and published by The Measurement Group
using results generated in its cross-cutting evaluation studies of the
27 HRSA SPNS Cooperative Agreements.
Questions or
Comments:
Contact The Measurement
Group.
Use of Knowledge Base
Information: Acceptable Uses and
Limitations.
Collaborators from
Participating Projects: Cooperative
Agreement Steering Committee 1999.
Participating
Projects: This Knowledge Base is based on
the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models
of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center were
funded by the Health
Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance
(SPNS)
between 1994 and 1999. Click the Model Programs button
in any individual Knowledge Item for descriptions of the projects that contributed to
the specific
Knowledge Item, a list of
key staff at the projects, and grant numbers.
Why This Evaluation was
Conducted: Editorial.
More Information: Design
of this Knowledge Base.
Recommended Citation
Format for Web Materials: American
Psychological Association Publication Manual Section, Revised 2001.
Work on the Knowledge Base and the
cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the
Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance
(SPNS). The contents of this Knowledge Base are
solely the responsibility of The Measurement Group and do not necessarily represent the official
views of HRSA or HRSA/HAB's Special Projects of National Significance
nor may they represent the positions of the individual grantees whose
projects are included in the cross-cutting evaluation.
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