Today starts like many others: on a conference call, discussing a complicated evaluation project. This project will look at how to improve the quality of HIV services in 53 large metropolitan areas around the United States. Five cities—Atlanta, Baltimore, Denver, Kansas City, and Oakland—have been selected to participate in a quality improvement initiative; JSI will analyze the initiative's impact.

Abbie Averbach from MDPH HIV/AIDS Bureau and Stewart Landers confer over needs assessment data at Suffolk University

Evaluating quality improvement is a challenge. There aren't many measures of quality that everyone agrees upon, except the result that people with HIV or AIDS are living longer, healthier lives. With treatment guidelines for HIV disease changing from year-to-year and with the epidemic reaching into more and more disadvantaged populations, it is difficult to determine a causal link between delivery of health care services—especially support services—and improved health outcomes.

While JSI's clients are usually public health entities, our focus is always on the people who live with HIV disease. Since I'm one of these individuals, I do understand the complex nature of this disease and how difficult it is for people to balance their physical health with complicated mental health needs, negotiations in relationships with spouses and partners, and staying afloat financially.

On the conference call with me are two other JSI staffers; three colleagues from the Harvard Medical School Department of Health Care Policy; and two Health Resources Services Administration (HRSA) staff who are working on a similar evaluation focused on coordination and integration of services. I have worked with many of these individuals on an earlier project, creating self-assessment manuals to assist the metropolitan areas in planning for HIV/AIDS services.

From this call, I head over to Suffolk University. The project I'm working on with researchers here also looks at delivery of HIV services, but is focused on the state of Massachusetts (and part of New Hampshire). The partners at the table include JSI, Suffolk University, the Boston AIDS Consortium, the Massachusetts Department of Public Health (MDPH) HIV/AIDS Bureau, and the Boston Public Health Commission (BPHC). Technically, MDPH is our client and has hired me to help represent its interests, as they partner with BPHC to conduct a services needs assessment of people living with HIV and AIDS (PLWH) across the state. The BPHC has partnered with Suffolk University twice before. Now MDPH joins BPHC in their work with Suffolk. The reason for joining forces is to spare PLWH from having to respond to two separate needs assessment surveys.

One challenge in this project is to reach a broad and diverse sample of PLWH while protecting the participants' confidentiality. Our process involves sampling through service providers and asking consumers to return postcards if they choose to participate. Already, some service providers have complained that the postcards violate confidentiality (although there is no mention of HIV or AIDS on the postcard). Even the smallest complaint must be addressed. We decide to offer providers the option of having postcards sent to consumers with stamped, addressed, envelopes. Another crisis averted!

After this meeting, I return to the office. A friend of a friend, who has lost his job in the current budget crisis, is due for an informational interview. I probably do fifteen to twenty of these a year. People are fascinated by what we do at JSI and want to know how they might fit in. However, this individual calls: the "T" has stalled between Porter and Harvard Squares, and he won't be able to make it in today. No problem, there's lots of evaluation and needs assessment data for me to review. When I succeed in turning data into useful information for communities, I am satisfied that we have improved health service delivery and made life a little better for individuals on the receiving end.

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