Assessing the Impact of the Ryan White CARE Act Title III Capacity Building Grant Program

1
Assessing the Impact of the Ryan White CARE Act
Title III Capacity Building Grant Program

• Presented by
• Shawn Aldridge
• with Shelly Harris, Nancy Mitchell, Sean Squire,
  Tammeka Swinson, Patrick Brown, Jeremy Green and
  Boyd Gilman
• RTI International
• Presented at
• RWCA Training and Technical Assistance Meeting
• August 28, 2006

2
Assessing the Impact of the Title III Capacity
Building Grant Program
Objective

• To evaluate the impact of the Capacity Building
  Grant (CBG) Program on grantee infrastructure
  capacity and HIV primary care service delivery.

3
Assessing the Impact of the Title III Capacity
Building Grant Program
Background

• Capacity Building definition Activities that
  promote organizational infrastructure development
  that lead to the delivery or improvement of HIV
  primary care services
• 4 Broad Infrastructure Development Elements
• Management Systems
• Service Delivery Systems
• Evaluation Systems
• Cultural Competency
• Up to 150,000 for 1 to 3 years

4
Assessing the Impact of the Title III Capacity
Building Grant Program
Background

• 91 CBG recipients FY 2001 2003
• 48 in 2001
• 29 in 2002
• 14 in 2003
• Length of grants
• One-year grants 42
• Two-year grants 36
• Three-year grants 13
• 80 grantees completed grants by Aug. 2004

5
Assessing the Impact of the Title III Capacity
Building Grant Program
Research Questions

• Did grantees accomplish their capacity building
  goals?
• What was the impact of the grant on provision of
  HIV primary care?
• What factors affected success of grant
  implementation and HIV primary care delivery?

6
Assessing the Impact of the Title III Capacity
Building Grant Program
Methodology

• Qualitative evaluation
• Documentation review
• Grantee profile
• Telephone discussions with 32 grantees August 8
  September 7, 2005

7
Grantees Interviewed Stratified by Award Year
Length
8
Assessing the Impact of the Title III Capacity
Building Grant Program
Methodology

• Additional Grantee Characteristics Included
• Organization type
• Prior HIV primary care experience
• Reported rural target population
• Capacity building goals

9
Geographic Location of Participating Grantees
10
Participating Grantees by Organization Type
11
Participating Grantees by Reported Population
Served
12
Participating Grantees by Grant Amount
13
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings

• Reasons for applying
• Factors affecting performance
• Impacts on infrastructure
• Impacts on HIV primary care provision
• Lessons learned
• Grantee recommendations
• Our recommendations

14
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings Reasons for Applying

• Enhance service quality by implementing
  electronic client record system
• Address financial management deficiencies
• Improve reporting capacity to HRSA others
• Address client confidentiality issues through
  clinic renovation
• Improve oral health of clients by expanding
  dental program
• Address lack of HIV primary care providers

15
Capacity Building Goals of Grantees
16
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings Internal Factors Affecting Performance

• HIV primary care experience ()
• CQI program ()
• Supportive leadership ()
• Prior strategic planning/needs assessment ()
• Staffing changes (delays, commitment level) ()
• Lack of computer IT literacy ()
• Insufficient planning/budgeting ()

17
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings External Factors Affecting Performance

• Community consumer involvement ()
• HRSA/HAB TA tools also AETCs ()
• Provider competition turfism ()
• Lack of partner follow-through/commitment ()
• Poor quality/untimely deliverables from
  consultants/vendors ()
• Rapidly changing healthcare market ()
• Lack of access to EIS funding ()

18
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings CBG Impacts on Infrastructure

• More efficient reliable data systems for
  medical records, reporting billing
• Improved policies, protocols standards
• Better trained provider support staff
• Better equipped facilities

19
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings CBG Impacts on HIV Primary Care

• MIS/IT
• Faster, more reliable collection, review
  exchange of data
• More efficient use application of data
• Telemedicine expanded improved care provision
• Networking of multiple sites improved care
  information exchange

20
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings CBG Impacts on HIV Primary Care

• CQI
• Development, updating, improvement of policies,
  protocols, standards
• Improved referral systems, MOUs, contracting
• Improved staffing levels qualifications
• Improved client education materials activities
• Increased consumer involvement in QA

21
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings CBG Impacts on HIV Primary Care

• More clinics providers ? expanded service
  access
• Better clinical financial management practices
  ? more clients served
• Use of telemedicine technology ? reduced
  emergency room visits
• Culturally appropriate marketing education
  materials ? increased case loads

22
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings Impact on Grantees without HIV Primary
Care Experience

• Pre-grant 10 grantees without HIV primary care
  experience
• Post-grant 7 providing HIV primary care (4 EIS,
  3 non-EIS)
• Remaining 3 seeking HIV primary care
• Supported necessary partnerships, technology,
  systems

23
Assessing the Impact of the Title III Capacity
Building Grant Program
Findings Lessons Learned

• In hindsight, would have added goals for
• Regulatory issues JCAHO accreditation HIPAA
  requirements
• Securing funding for maintenance further
  development of systems
• Securing non-EIS funding for HIV primary care
  support
• Securing funding for staff loss due to regulation
  changes

24
Assessing the Impact of the Title III Capacity
Building Grant Program
Grantee Recommendations

• Continue CBG Program but more EIS
• More explicitly narrowly define capacity
  building
• Target CBG for infrastructure developments
  having most impact on HIV primary care provision
• More HRSA oversight TA on realistic goals,
  activities timelines MIS/IT assessment
  possible regulatory issues

25
Assessing the Impact of the Title III Capacity
Building Grant Program
Our Recommendations

• Target use of CBG funds
• Target access to CBG funds (prior HIV primary
  care / PG experience)
• Ensure access to complementary funding (PG EIS)
• Ensure adequate HRSA/HAB CBG guidance TA
  (non-EIS funding assessing needs, IDing
  realistic goals, activities timelines, IDing
  desired results)

26
Participating Grantees Prior Current HIV
Primary Care EIS Funding Experience
27
Thank you