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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1027 — Regional Rollout of a Program to Improve HIV Testing Rates

Goetz MB (VA Greater Los Angeles HCS), Knapp H (VA Greater Los Angeles HCS), Henry SR (VA Greater Los Angeles HCS), Hoang T (VA Greater Los Angeles HCS), Anaya H (VA Greater Los Angeles HCS), Gifford A (VA New England HCS), Asch S (VA Greater Los Angeles HCS)

Objectives:
We analyzed whether a successfully implemented program that used a clinical reminder, organizational changes, clinic-level feedback, and provider activation to promote HIV testing at two academically oriented VISN22 facilities (HCS A and B) that provide tertiary care could be successfully rolled out to other VISN22 facilities that provide less complex services (HCS C and E) and lack strong academic affiliations (HCS E).

Methods:
All aspects of the intervention were implemented as a single package at HCS A, B, and C. In contrast, at HCS E, the provider activation component of the program was implemented four months after the other components in an effort to ascertain the contribution of this, the most labor- and time-intensive component of the intervention. The rates of HIV testing before and after the implementation of the intervention were compared across the two initial and two subsequent facilities; VISN22 HCS D served as a control. Data were obtained from the VISN22 data warehouse.

Results:
Across the 5 HCS, baseline yearly rates of HIV testing among previously untested, at-risk persons were 2.3 – 6.7%. During the year after program implementation these yearly rates increased by 9.3% - 12.4% for HCS A and B vs 5.8 – 16% for HCS C and E. There was no change in the testing rate at the control facility (HCS D). Despite the four-month delay in implementing the provider activation program at HCS E, there was an increase in the HIV test rate from 1.4% at baseline to 7.1% in the first month after institution of the other components of the intervention.

Implications:
A multimodal intervention consisting of the coordinated use of computerized real time clinical reminders, audit/feedback, provider activation, and removal of systemic barriers that was previously shown to significantly increase HIV testing rates in two academic, tertiary care provider VA facilities in VISN22 was successfully rolled out to two other VA facilities with differing characteristics. Further work is needed to determine the contribution of the provider-activation component of the program.

Impacts:
These results provide a firm basis for additional research assessing the implementation of this successful quality improvement intervention in other VA facilities. In addition, these results suggest that multimodal intervention programs developed at complex centers can be successfully disseminated across other facility types.


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