The Golden Compass Program: Overview of the Initial Implementation of a Comprehensive Program for Older Adults Living with HIV.

The population with HIV is aging and has unique health needs. We present findings from an evaluation of the geriatric-HIV program, Golden Compass, at San Francisco General Hospital. We used the implementation science framework, RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to guide the evaluation and used quantitative and qualitative methods to assess RE-AIM dimensions. From January 2017 to June 2018, 198 adults age ≥50 years participated in the program, with an estimated reach of 17%. Providers and patients indicated high acceptability of the program and were satisfied with clinics and classes. Colocation of services, specific pharmacy and geriatric assessments, and social support from classes were valued (effectiveness). Provider adoption was high, and the program was implemented as originally designed. Areas for improvement included challenges of framing aging services to patients. Future efforts will focus on expanding the reach of the program and examining long-term outcomes.

Patient and provider perceptions of a comprehensive care program for HIV-positive adults over 50 years of age: The formation of the Golden Compass HIV and aging care program in San Francisco.

OBJECTIVE: People living with HIV (PLWH) are living longer and developing comorbidities and aging-related syndromes. New care models are needed to address the combined burden and complexity of HIV and its comorbidities in this group. The goal of this study is to describe qualitative data from patients and providers that informed the development of a comprehensive care model for older PLWH. METHODS: Patient and provider perspectives on the clinical care and service needs of patients living and aging with HIV were explored via surveys and focus groups at a safety net HIV clinic in San Francisco. We surveyed 77 patients and 26 providers and conducted separate focus groups of older patients living with HIV (n = 31) and staff (n = 20). Transcripts were analyzed using thematic analysis. Themes for a care program were additionally explored using findings from the literature on HIV and aging. FINDINGS: Themes from surveys and focus groups emphasized (a) the need for knowledge expertise in HIV and aging, (b) focus on medical conditions and determinants of health of particular import (e.g. marginal housing) among older PLWH, (c) co-locating specialty services (e.g. cardiology, geriatrics) with primary care, and (d) addressing social isolation. Findings informed the design of a comprehensive, multidisciplinary care model for PLWH called the Golden Compass program composed of four "points": Heart and Mind (North), Bones and Strength (East), Network and Navigation (South), and Dental, Hearing, and Vision (West). CONCLUSION: Based on patient and clinic staff perspectives from surveys and focus groups, we designed a multidisciplinary program of integrated primary and specialty care, as well as housing and social support, to address the needs of older PLWH within a safety-net infrastructure. Golden Compass launched in 2017 for PLWH older than 50 years. Future research to evaluate the effectiveness of this care program in improving patient outcomes and satisfaction is ongoing.

Doing More With Less: A Centralized Model for Fellowship Program Coordination.

BACKGROUND: Pediatrics fellowship programs typically are small, embedded in divisions, and vary in their approach to education. Program coordination usually falls to division administrators who operate in silos despite common requirements across programs, creating redundancy and inefficiency. OBJECTIVE: We examined the feasibility, acceptability, and impact of a centralized administrative model for pediatrics fellowship support at a large university-based institution. METHODS: In 2014, administrative support for the pediatrics fellowships at the University of California, San Francisco, was restructured from a model with division-level support to a centralized model. In the new model, a team of 6 full-time administrators supports 19 fellowship programs with a total of 80 fellows. The fellowship support team consists of 3 program coordinators, a data coordinator, a human resource coordinator, a team manager, and a faculty advisor. The team meets twice a month to discuss program issues and innovative ideas. Quarterly meetings are held with all coordinators and directors to discuss changes across fellowships and foster further collaboration. We surveyed program directors to examine the acceptability of the model and assessed its impact on finances and turnover. RESULTS: Of 19 eligible fellowship program directors, 15 (79%) completed the survey. The majority indicated that the new administrative model was "better" or "much better" than the prior model. The new model resulted in decreased costs (an estimated $250,000 per year in salary support) and lower staff turnover. CONCLUSIONS: Centralization of fellowship administration is feasible and offers substantial benefits for all stakeholders involved.