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Duke Health News

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Note to editors: A news conference will be held at 1:30
p.m., on Monday, Nov. 11, at Brody Medical Sciences Building,
room 2W-50, on the East Carolina University School of Medicine
campus, in Greenville. For broadcasters, beta B-roll is
available at the news conference or from Duke. The B-roll
contains footage of participating doctors describing the
program and an AIDS patient explaining what the program will
mean for patients.

For more information about the news conference, contact Tom
Fortner at ECU.

GREENVILLE, N.C. -- Three of the state's academic medical
centers are joining forces with local health and social
services providers in rural eastern North Carolina in a novel
program designed to streamline care for HIV-infected Medicaid
patients.

The model community-based rural program, among the first of
its kind in the nation, will coordinate the work of health care
professionals and government agencies to ensure that patients
receive optimal medical care and timely access to services. The
program is funded by a five-year, $2 million grant from the
Health Resources and Services Administration (HRSA), part of
the U.S. Department of Health and Human Services, and also will
be funded, in part, by payments from North Carolina
Medicaid.

The project, developed by researchers at Duke University
Medical Center in Durham, will link Duke, the University of
North Carolina Hospitals and the UNC School of Medicine in
Chapel Hill and East Carolina University School of Medicine,
Greenville, -- the three major medical centers serving patients
in eastern North Carolina -- with the AIDS Care Branch of North
Carolina, local social services and medical caregivers.
The goal is to provide one umbrella organization that will
follow all Medicaid-eligible, HIV-infected adult patients to
make sure their needs are met. The researchers will spend a
year implementing the program and will begin enrolling about
600 current Medicaid patients next fall. Eventually, the
researchers expect to enroll about 1,500 people in 53 eastern
North Carolina counties.

"We are hoping to bring coordinated care to an area of the
state where we know the rate of HIV infection is growing most
rapidly," said Kate Whetten-Goldstein, director of the project
and assistant research professor in Duke's Center for Health
Policy Research and Education.

The Centers for Disease Control and Prevention (CDC) has
identified the southeastern United States as an important
epicenter for the spread of HIV infection, with about 126
people in 100,000 infected, including those with active AIDS.
In 1995, the national rate of HIV infection, including active
AIDS, was 27.2 in 100,000. In contrast to other areas of the
country where HIV is concentrated in urban areas, many of these
new HIV-infected people are living in Southern rural
communities. Right now there are no coordinated programs to
care for these people, who live in a large geographic area
where few social workers are available, the researchers
said.

It is more difficult in rural areas to find doctors and
dentists who are willing to take care of people who are HIV
positive, Whetten-Goldstein said. Many of these people want to
remain anonymous in their communities and travel great
distances to major medical centers for care to preserve their
anonymity. This program will be among the first to attempt to
coordinate care of HIV/AIDS patients in a rural setting. It is
funded by one of 19 grants awarded in September under the Ryan
White CARE Act to improve care of AIDS patients in rural
communities, among migrant workers and other underserved
communities.

"People often are unaware of what services are available to
them," Whetten-Goldstein said. "Our hope is that this program
will be a kind of glue that will hold together a large number
of medical and social services that are not now coordinated in
any formal way. We are not trying to change the system that is
in place; we are enhancing that system."

Among the objectives of the new program are:

- Coordinate major medical care among the three
participating medical centers -- Duke, UNC, and ECU -- which
will remain the hub of HIV/AIDS treatment for patients.

- Hire case coordinators to track patients' medical and
social needs and work with individual case workers already in
place to ensure continuity of care.

- Develop a computer network to assist case coordinators in
tracking all health and social services Create "care maps" --
detailed patient protocols that guide health care providers in
selecting the appropriate level of care for each patient
depending on their individual needs.

- Locate local health care providers, such as primary care
physicians and dentists, who will treat HIV-infected patients
for routine needs.

- Provide transportation to medical appointments.

- Locate local support groups, home health care providers,
substance abuse treatment programs, and other medical and
social support for rural HIV patients.

- Explore the feasibility of a model capitated payment
system for HIV/AIDS Medicaid patients.

- "Access to care is a critical issue," said Dr. John
Bartlett, director of Duke's AIDS clinic. "Many of our patients
from rural communities are living in impoverished conditions
and have difficulty with access to transportation, information
and new treatments for HIV. This network will allow patients to
receive care in their own communities, and when appropriate,
referral to one of the three participating academic medical
centers."

- By combining all health care, clinic visits, lab work,
home health, hospice care, housing supports, transportation and
social services into one coordinated program, the researchers
hope to streamline care for a fixed fee.

- "This is an opportunity for us as health care
professionals to use our expertise in treating HIV-infected
patients to design a managed care strategy that will be both
cost effective and improve the quality of services that we are
able to provide," said Dr. Joseph Eron, director of UNC's
Infectious Disease Clinic.