Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3046 — Development and Implementation of a Clinical Reminder for HIV Testing

Author List:
Goetz MB (VA Greater Los Angeles HCS)
Rossman BL (VA Greater Los Angeles HCS)
Hoang T (VA Greater Los Angeles HCS)
Anaya H (VA Greater Los Angeles HCS)
Burgess J (VA Public Health Strategic Healthcare Group)
Volpp BD (VA Northern California Healthcare System)
Osborn T (VISN 22 Network Office)
Bowman C (VA San Diego Healthcare System)
Gifford A (VA San Diego Healthcare System)
Asch S (VA Greater Los Angeles Healthcare System)

Objectives:
HIV testing is done in <40% of at-risk VA patients. We are conducting a pilot test of an integrated quality improvement (QI) project, the goals of which are 1.) to determine whether rates of HIV testing increase after implementation of this QI program); 2.) to determine the barriers to increased HIV testing within the VA; 3.) to develop a “Business case” analysis of HIV testing; and 4.) to develop an exportable model for increasing VA HIV testing rates nationally.

Methods:
We are implementing this QI project in 2 facilities in VISN 22; 3 other facilities serve as controls. This project relies on 1.) audit/feedback, i.e., a context-specific, computerized clinical reminder (CR) for HIV testing, and facility and clinic level feedback using an HIV testing performance monitor; 2.) provider activation via proven academic detailing and social marketing methodology; and 3.) removal of systemic barriers to facility and clinic level performance of HIV testing. The outcomes of this intervention are being evaluated qualitatively (i.e., via surveys of providers) and quantitatively (assessment of HIV testing rates in facilities that do or do not receive the intervention).

Results:
Preliminary analyses indicate that after one month the rate of HIV testing in previously untested, at-risk individuals increased from 33 to 46% at one intervention facility and from 23% to 42% at the other such facility. No change in test rates was seen in the three control facilities.

Implications:
Our preliminary results suggest that the coordinated use of audit/feedback, provider activation, and removal of systemic barriers may result in significant increases of HIV testing rates for at-risk VA patients. We plan to evaluate the durability/sustainability of the intervention effect, the costs of HIV testing, and the number of newly identified HIV-infected patients over the forthcoming year. The next step will be to evaluate the utility of this intervention in other geographically dispersed VISNs across the US.

Impacts:
Implementation of a quality improvement project using audit/feedback, provider activation, and removal of systemic barriers has the potential to significantly increase the rates of HIV testing of at-risk patients in the VA and thus allow early diagnosis and treatment for these vulnerable patients.