Ryan White CARE Act Title IV: building networks to improve healthcare delivery to the HIV infected.

There has been little evaluation of the implementation of HIV consortia that were created under Title IV of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. In 1993, Mor and colleagues reported that the effectiveness of networks established by the Robert Wood Johnson Foundation had been compromised by the inability of the participating agencies to work together, given their competing goals and varied institutional cultures. In a study published in 1995, Roy and colleagues identified the following as determinants of successful project implementation: federal and local government support, management-level support and technical assistance, and linkages between participating agencies. This article describes the role that network infrastructure can play in developing interagency collaboration, and the importance of network infrastructure in coordinating the delivery of care at the service-delivery level. The authors describe the efforts of the Lower New York Consortium for Families with HIV (hereafter, "the Consortium") to develop integrative mechanisms at both the network level and the program level. As the number of infected women grows, so does the need to improve the delivery of services and to reduce barriers to the receipt of care. In itself, the support of individual agencies that provide case-management services may not be enough to improve service delivery and reduce barriers; the experiences of networks such as the Consortium may help inform the development of guidelines for creating and enhancing the coordination of services to assure improvements in care. Systematic studies are needed to evaluate different models of collaboration and of coordinating care to determine whether the effort to develop consortia is justified by improved access to care and improved health.

Measuring HIV/AIDS case management.

Studies of HIV/AIDS case management have been limited by their almost exclusive focus on adults and by the limitations of available methodologies. This study assesses the use of a time study methodology to measure the case management activities of 20 case managers in two urban hospital pediatric and adult HIV/ AIDS clinics and in 3 community organizations. Case management activity was sampled using a beeper case managers carried, which signaled randomly 8 times a day over 5 consecutive days. When the signal "beeped", case managers checked on a form the appropriate descriptor of their involvement in case management tasks and with different clients. The results suggest that the Time Study methodology is a useful and valid way of measuring case management.

Measuring case management for families with HIV.

Case management has been recognized as a major way for coordinating the multiple services needs for people with HIV/AIDS. Such coordination is required because of the progressively debilitating nature of this chronic disease and the fragmented health care and social services delivery system. One of the major problems with the study of case management is the difficulty in actually measuring it. Another major limitation has been the focus almost exclusively on adult models of HIV/AIDS case management. This study was undertaken to assess the efficacy of a time study methodology to measure differences in case management activities when case managers work with families and when they work with individuals. Ten case managers from two urban hospital pediatric and adult HIV/AIDS clinics and 10 case managers from 3 community organizations participated. Case management activity was sampled using a beeper carried by case managers which signaled randomly 8 times a day over 5 consecutive days. When the signal "beeped", case managers checked off on a 1-page form the appropriate descriptor of their involvement concerning task initiation, interaction, location, type, function as well as information about client needs, HIV status, and family history. The results suggest that the Time Study methodology is a useful and valid way of measuring case management and of identifying differences in case mix, client need and background, and case management techniques when case managers work with families and with individuals.