 |
|||||||||||
27 HIV Innovative Models of Care
Cooperative Agreements Funded in 1994
Progress During the Second Year:
A Summary Report
A Report by the Cooperative
Agreement Steering Committee
Executive Summary
On October 1, 1994, the Special Projects of National Significance (SPNS) Program of the Health Resources and Services Administration (HRSA) funded an HIV Innovative Model of Care Initiative consisting of 27 cooperative agreements, HRSA, and an Evaluation and Dissemination Center. The individual projects were funded for periods ranging from two to five years.
For the purposes of managing the cooperative agreements, sharing project expertise, and permitting cross-cutting evaluations, projects initially were assigned to one of five clusters based on similarities in methods, outcomes, and/or processes.
- Capitated Care. Five of the projects share, as a central theme, the study of the health care provided to individuals with HIV disease under models where the health care is capitated, or paid on a "flat fee" basis per patient per month.
- Community-Based Organization Models. Six of the projects share, as a central theme, the goal of providing high-quality care for individuals with HIV who belong to groups that are traditionally underserved because of linguistic, cultural, racial, and economic barriers that prevent their full integration into the traditional hospital-based service system.
- Comprehensive Healthcare. Three projects are developing specialized medical care models within the context of a continuum of services in a medical clinic.
- Infrastructure-Advocacy. Seven projects in the Infrastructure-Advocacy group aim to increase the capacity of local health and social support service systems to provide appropriate, quality services for individuals with HIV. The projects in this group are using service system development methods through training and technical assistance to change the service provider infrastructure, as well as the community context in which services are delivered.
- Training. While training is integral to almost all projects, seven have identified training among their most key elements.
At the end of its first year, the Steering Committee of the Cooperative Agreements issued the first installment of this annual report. In that report the Committee listed its collective achievements as well as the achievements of individual projects. At the same time, the Committee specified goals for the second year.
This report adds to the previous volume by examining the progress of the Steering Committee after two years. A historical overview of the HIV Innovative Model of Care Initiative is presented in Chapter 1 of this report.
Individual project achievements are described in Chapter 2. During the second year, the Steering Committee met four times in two-day meetings. Additionally, the members of the Steering Committee met in various combinations in more than 100 conference calls. Among the major achievements of the Steering Committee during the second year were the following:
- Continued Development of Common Objectives. During the course of the four second-year Steering Committee meetings, individual Work Groups met for at least six hours at each meeting. During the course of these meetings, discussions revolved around a number of themes. While the themes differed slightly among the Work Groups, a number of common objectives were developed in each group. As contrasted to the first year, in the second year each of the Work Groups established specific objectives, specified joint dissemination products, and established timelines for the completion of collaborative work.
- Sharing Project Expertise, Methods, and Resources. A significant part of the work of the Steering Committee was to ensure that there were mechanisms for sharing project expertise, methods, and resources. The Steering Committee employed a number of techniques for improving communication, engaging in project cross-training, sharing costs of developing common evaluation methods, and exchanging information needed by several projects. At the four meetings of the Steering Committee there were site visits to two projects, 13 formal presentations by projects on their progress, and 75 discussions of general interest. Five medical doctors, each representing a different project, provided a half-day training session for all projects on the current state-of-the-art in the medical management of HIV. This training covered new drug therapies including protease inhibitors, therapies for opportunistic infections, and viral load measurements for all age groups.
- Development of Common Evaluation Methods and Protocols. In the first year, the Steering Committee adopted a modular evaluation design wherein standardized short forms of 1-2 pages were developed for a number of different functional evaluation questions. By using common modules across projects, as much comparable data as possible will be obtained. By the end of the second grant year, data had been collected on 1,595 individuals, 10,728 therapeutic interventions, 631 trainings, 16,702 individuals trained, and 130 trainers.
- Development of a Governance Structure For Making Major Committee Decisions. Significant work was undertaken during the first project year to develop organizational and governance structures for the cooperative agreement projects. The governance structure was maintained into the second year and further elaborated where it proved to be effective for the Cooperative Agreements.
- Poster Session and Formal Presentation to the Administrator of HRSA. At the April meeting of the Cooperative Agreement Steering Committee in Washington, D.C., a formal presentation was made of the first-year report of the Steering Committee to the Administrator of HRSA. At the same time, a poster session was held for the entire afternoon in which virtually all projects presented their first-year results. The poster session was attended by more than 100 outside representatives of federal agencies and other groups concerned with HIV/AIDS policy and HIV/AIDS treatment models. The Program for the poster session is included as Appendix IV to this report.
- Presentation of the Cooperative Agreement Steering Committee’s Work at the 11th International AIDS Conference. The Cooperative Agreement Steering Committee did a joint presentation on its work and methods for ensuring successful goal setting and collaboration at the International AIDS Conference in Vancouver. A copy of that presentation is included as Appendix II to this report.
- Dissemination of Project Results. Results from the projects were distributed by the Evaluation and Dissemination Center in three electronic forms. A faxed newsletter was distributed every two weeks to key stakeholders. In addition, a World Wide Web site was developed (www.TheMeasurementGroup.com/edc.htm) which includes many key documents, results, and evaluation tools from this project. Finally, a fax-on-demand system was developed so that the major documents from these projects would be available 24 hours per day.
Individual project goals and objectives for the third year are given in Chapter 3. During the second year of its existence, the Steering Committee identified three large-scale objectives for the third year of its collective efforts. These objectives for the third year are:
- to continue to evaluate a set of common objectives among relatively comparable projects and to enhance the common data set in order to evaluate those common objectives;
- to share expertise among projects, both formally and informally; and
- to continue to report and disseminate the successes and experiences of the projects.
Specific exemplars of these third-year plans are given in Chapter 3.
© Copyright 1998-2005 by The Measurement Group LLC. All rights reserved.