1029 — VISN-Wide Implementation of a Program to Increase HIV Testing Rates
Plumb DN, COE - Bedford, VA New England Healthcare System; Atkins WJ, and Evans JS, Bedford VA New England Healthcare System; Czarnogorski M, and Ross D, VA National Clinical Public Health Program; Drainoni M, COE - Bedford, VA New England Healthcare System; Vasquez LS, VA Connecticut Healthcare System; Gifford AL, COE - Bedford, VA New England Healthcare System;
VISN 1 provides primary care to 250,000 Veterans across New England and utilizes an electronic medical record across eight facilities. Despite emphasis for routine HIV testing in VHA, VISN 1 had among the lowest rates of testing in the VHA system. In response, we implemented an HIV testing program based on a successful VA research study that used an electronic clinical reminder, testing support/education for providers, and performance feedback to increase HIV testing. The goal was to implement routine HIV testing procedures in VISN 1 and generate a three-fold increase in percent testing at each facility.
The program was implemented in primary care at all facilities for one year. It used an HIV clinical reminder that electronically prompted providers to offer testing and that could be resolved if an HIV test was ordered or a patient refused testing. Program staff met with primary care teams at each facility to educate and encourage use of the reminder and HIV testing, as well as to provide monthly performance feedback. Data were compared across facilities six months prior to and post program implementation and obtained from corporate and clinical reminder reports.
Across sites, the reminder was resolved 67.9% of the time, most often by HIV tests ordered (29.3%) or patient refusal (64.3%). There was a significant increase in tests completed at all sites post program implementation (1.5% to 10.0%, p <0.0001). The refusal rate across sites ranged from 24% to 78%. Seven sites had more refusals (49.6% to 78.5%) than tests ordered (18.1% to 39.1%). One site had more tests ordered (58.2%) than refusals (30.4%) and also the highest rate of tests completed (13.2% compared with 8.0% to 12.0%).
With funding from the VA National Clinical Public Health Program, this implementation program to increase HIV testing in primary care utilizing an electronic clinical reminder, provider support and education, and feedback, was successful in VISN 1. Further work is needed to evaluate the factors contributing to the resolution rates in VISN 1 and the sustainability of the program overall.
The results support the success of a clinical reminder in improving targeted HIV testing interventions.