Program Abstract

The HIV service continuum of care in this border region is being seriously challenged from many converging forces at this time.  The area’s sole comprehensive AIDS service organization closed in December 1998 due to financial problems.  Medicaid managed care rolled out in El Paso in the last month of 1999; reimbursement rates continue to be less along the border than in the rest of the State.  The increases in the complexity and costs of diagnostic and treatment modalities put additional burdens of service delivery on budgets and staff to provide quality care to growing caseloads of clients with greater levels of acuity.  The resulting impact is that the traditional system of case management, with its mainly social service functions, is proving less than adequate to meet the changing healthcare needs of HIV/AIDS clients today.

This grant proposal will create multidisciplinary care teams composed of nurses, positive peer advocates, and a nutritionist to offer combined social and medical case management in the form of a disease management approach that is being used to address other chronic diseases that can be devastating to patients and very expensive to those paying for care.  A major component of this model will be treatment adherence assessment, education, and counseling to be performed by all team members according to detailed job descriptions and project protocols.  This study will attempt to formally document the differences in patient outcomes – clinical, personal, and financial – that are found with the existing case management method as compared with this enhanced version of coordinated care.
  
Planned project activities include the formation of two disease management teams, each consisting of two registered nurses (Care Managers) and two part-time positive peer advocates (Caseworkers).  The role of the nurse will be an expanded one, with assessment and participatory guidance for nutrition, substance abuse, mental health, medication adherence, and other health promotion concerns; nurses may also offer limited clinical preventive services, especially related to wellness issues.  Currently employed Case Managers will be included on the two new teams.  A Registered Dietitian will complement and assist both teams.  The anticipated caseload for each team will be about 150-200 clients.

The disease management project will be located at the area’s only comprehensive “one-stop shop” for HIV health and support services – the La Fe CARE (Community Advocacy, Resources, and Education) Center.  Two local institutional partners for this SPNS initiative are the Department of Internal Medicine of the Texas Tech School of Medicine’s Virology Clinic and the International AIDS Empowerment, El Paso’s only client-based organization.  The combined community, academic, and consumer strengths of these three agencies will be supported by the technical assistance and program consultation of the AIDS Healthcare Foundation of California and Florida, which has nationally recognized expertise in disease management for managed care populations.

The evaluation and dissemination plans will be directed by the Department of Psychology at the University of Texas at El Paso (UTEP).  Its professors and students in the graduate program of health psychology will conduct qualitative and quantitative research to document, measure, and report the successes and shortcomings of this border intervention model of coordinated care.