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Program Collaboration and Service Integration (PCSI) at NCHHSTP

Slide Set H: PCSI: An NCHHSTP Green Paper

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 Program Collaboration and Service Integration: An NCHHSTP Green paper

Kevin Fenton, M.D., Ph.D., F.F.P.H.
Director 
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 
Centers for Disease Control and Prevention

August 21, 2007
Slide 1

Program Collaboration and Service Integration, an NCHHSTP Green paper
PDF File or PPT File

 


Overview

Background on Green Paper
Levels of integration 
Slide 2

Overview
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 Program Collaboration and Service Integration: Enhancing the prevention and control of HIV/AIDS, Viral Hepatitis, STD and TB in the United States

NCHHSTP green paper, July 2007
Green paper: a discussion document intended to stimulate debate and launch a process of consultation

Paper describes how NCHHSTP will work with partners to advance PCSI strategic priority
Slide 3

Program Collaboration and Service Integration: Enhancing the prevention and control of HIV/AIDS, Viral Hepatitis, STD and TB in the United States
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 Program Collaboration and Service Integration Drivers, Opportunities, and Motivators

Overlapping determinants, programmatic responses, interventions for HIV, Hepatitis, STD, TB prevention
Moving towards a more holistic model of prevention services
Need to accelerate reductions in health disparities
Desire to improve delivery of prevention services to clients
Advances in diagnostic technology and treatment 
More efficient use federal resources
Slide 4

Program Collaboration and Service Integration Drivers, Opportunities, and Motivators
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Program Collaboration and Service Integration Conceptualizing a national strategy

Where are we now?
What do we want to achieve?
Can we articulate a shared vision for PCSI?
How do we get there?
Develop an agreed typology for PCSI
Determine current distribution of integrated services
Clarify roles, responsibilities and governance
Establish training, policies, guidelines for transformation
Monitor and evaluate progress towards implementation
Measure and reward performance 
Slide 5

Program Collaboration and Service Integration - Conceptualizing a national strategy
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Program Collaboration and Service Integration Where are we now?

Limited integration of services
Marked variations across the United States
Numerous models of best and promising practice
Numerous barriers to integration
Programs have concerns about implementing
Unclear support and incentives for integration
No national leadership on PCSI 
Slide 6

Program Collaboration and Service Integration - Where are we now?
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 Program Collaboration and Service Integration Where do we want to be?

Goal: 
Provide prevention services that are holistic, science based, comprehensive, and high quality to appropriate populations at every interaction with the health care system.

Vision:  
Remove barriers to and facilitate adoption of service delivery integration at the client level by aligning NCHHSTP activities, systems, and policies with this goal.
Slide 7

Program Collaboration and Service Integration - Where do we want to be?
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Program Collaboration and Service Integration A typology for integrated HIV, Hepatitis, STD and TB preventive services

Comprehensive integration
Service integration across systems of care (CDC or other) based on risk assessment

Expanded Integration
Service integration across programs funded by CDC based on risk assessment

Limited integration
HIV testing
Some integration of health information

No Integration 
Slide 8

Program Collaboration and Service Integration - A typology for integrated HIV, Hepatitis, STD and TB preventive services
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Program Collaboration and Service Integration Level 1 (Limited) Integrated Services

Definition:
Basic core of integrated services with HIV testing being the basic intervention (independent of risk, age, behavior)
 
Services
Routine HIV testing in line with 2006 CDC revised recommendations
Health information on HIV, STD, viral hepatitis, and TB
Documented and tracked referrals to Level 2, 3, or specialist services available on request or as indicated
HIV+ linked to care 
Slide 9

Program Collaboration and Service Integration - Level 1 (Limited) Integrated Services
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Program Collaboration and Service Integration Level 2 (Expanded) Integrated Services

All onsite services from Level 1 
Chlamydia screening and treatment for women <25
Gonorrhea screening
Syphilis testing
Treatment for CT, GC, syphilis
Hepatitis A/B vaccine
Hepatitis C risk assessment
Expedited partner therapy, partner notification or Partner Counseling Referral Services
Pregnancy testing as indicated
Screening for TB exposure/risk
Condoms available
Documented and tracked referrals to Level 3 or specialists 
Slide 10

Program Collaboration and Service Integration - Level 2 (Expanded) Integrated Services
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Program Collaboration and Service Integration Level 3 (Comprehensive) Integrated Services

All onsite services from Level 2
Comprehensive sexual and reproductive health risk assessment, drug use, mental health, intimate partner violence risk assessment
Comprehensive HIV, Hepatitis A/B and Hepatitis C, STD, TB screening, diagnosis and treatment
Comprehensive health services, including pregnancy testing and contraceptive services
Health education and targeted risk reduction
Referral to specialist as needed 
Slide 11

Program Collaboration and Service Integration - Level 3 (Comprehensive) Integrated Services
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 Program Collaboration and Service Integration Roles and responsibilities

CDC’s responsibilities
Support greater coordination and communication among programs
Encourage more joint site visits
Provide national guidance and recommendations on standards for PCSI and performance indicators
Conduct periodic assessments of coverage and quality of integrated services
Collate national monitoring and evaluation data on PCSI implementation from grantees
Support training, policy, and guideline development
In consultation with partners, explore funding opportunities
Slide 12

Program Collaboration and Service Integration - Roles and responsibilities
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PProgram Collaboration and Service Integration Roles and responsibilities

Grantees, other stakeholders and partners
Design, implement, monitor and evaluate integrated services
Assess quality of services
Develop systems to collect, report, and analyze key integration performance indicators
Support training, policy and guideline development
Identify local funding opportunities to support integration of prevention services 
Slide 13

Program Collaboration and Service Integration - Roles and responsibilities
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 Program Collaboration and Service Integration Training, policies, guidelines for transformation

NCHHSTP acknowledges that successful implementation of PCSI will require ongoing training and support for prevention workers in a variety of health care settings over sustained periods. 

In addition to providing clear recommendations and expectations for PCSI, NCHHSTP is committed to supporting state and local programs in PCSI through:
Work with Prevention Training Centers 
Using new technologies (e.g. Internet, blogs, listserves) 
Partnering with professional agencies 􀂾 
Producing integrated guidelines 
Supporting ongoing dialogue and information exchange 
Share progress data on PCSI implementation 
Change NCHHSTP grants and cooperative agreements
Slide 14

Program Collaboration and Service Integration - Training, policies, guidelines for transformation
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 Program Collaboration and Service Integration Monitoring and evaluating progress

CDC ensures the quality of its programs and projects through regular monitoring, evaluation, audit and other oversight activities. 

Both monitoring and evaluation are key components to the successful implementation of PCSI across existing prevention services.

Monitoring and evaluation consists of process measures and performance indicators.
Slide 15

Program Collaboration and Service Integration - Monitoring and evaluating progress
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 Program Collaboration and Service Integration Measuring and rewarding performance

Performance indicators help to demonstrate the degree to which program objectives have been achieved. 

They allow a comparison of what is happening with what was planned, and provide insight into what should be done to tell whether an activity is on schedule and implemented as planned. 

What potential performance indicators may be used alongside the PCSI Levels of Integration framework?
Slide 16

Program Collaboration and Service Integration - Measuring and rewarding performance
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Summary

Where are we now?
What do we want to achieve?
Can we articulate a shared vision for PCSI?
How do we get there?
Develop an agreed typology for PCSI
Determine current distribution of integrated services
Clarify roles, responsibilities and governance
Establish training, policies, guidelines for transformation
Monitor and evaluate progress towards implementation
Measure and reward performance 
Slide 17

Summary
PDF File or PPT File

 

 
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