Evaluation and Optimization of the Philadelphia Medical Case Management Model

Why It Matters

The evaluation targets the ‘treat’ pillar of the federal EHE effort, aiming to improve retention and outcomes for people with HIV through scalable, evidence-based case management—potentially accelerating viral suppression and reducing transmission at the municipal level. Embedding research capacity in public health practice creates a model for other jurisdictions to rapidly translate data into improved HIV care delivery.

Summary

City and university leaders detailed a partnership-led evaluation of Philadelphia’s Ryan White EMA medical case management model aimed at strengthening HIV treatment under the Ending the HIV Epidemic initiative. The Philadelphia Department of Public Health and the University of Pennsylvania School of Social Policy and Practice, with partners including Penn CFAR, Lincoln University and the Yale R3EDI Hub, are using equity-driven, data-informed methods to assess and optimize client-centered, low-barrier case management services. The work engages medical case managers, supervisors and clients directly and embeds academic expertise and biostatistical support into the health department to translate findings into practice. Presenters emphasized cross-sector collaboration and implementation science to close gaps in care in this high-HIV-morbidity, majority-minority city.

Original Description

Under the Centers for AIDS Research (CFAR) umbrella, the Philadelphia Department of Health and the University of Pennsylvania partnered to contribute to our understanding of how to enhance capacity for local service delivery. We used a team approach involving a new collaboration among the Philadelphia Department of Public Health and community-based Medical Case Management (MCM) agencies, investigators at Historically Black University Lincoln University, and the School of Social Policy & Practice (SP2) at the University of Pennsylvania.

Using an implementation science approach, guided by the RE-AIM for Equity Model (Shelton et al 2020), our team evaluated the operationalization of the new MCM model that triages clients to comprehensive or standard levels of care. Key goals were to (a) learn whether Ryan White (RW) care sites are using the new MCM model and whether adoption varies by site characteristics, such as location in medical practices or community-based organizations; (b) determine if clients are triaged to the level of MCM that is most appropriate for each person’s need; and (c) if not, identify how implementation of the MCM model might be improved to enhance program outcomes.

Because this project engaged a collaborative team including the Philadelphia Department of Health, which oversees and funds MCM, and community-based organizations that implement MCM, the project provided critically needed information to mitigate unintended structural barriers to HIV treatment and prevention and transform these processes. Through team science and a focus on academic/community research partnerships, the project provided the basis for developing linkages and future collaborations among the partners, leading to the development and testing of a novel approach to implementing an enhanced MCM model.