377. Improving rates of HIV screening in a Midwest primary care practice using an electronic clinical decision support system
Session: Poster Abstract Session: HIV Epidemiology: Screening and Testing - Outpatient to Inpatient
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Marcelin_IDWeekPoster 2015.pdf (266.1 kB)
  • Background: Universal human immunodeficiency virus (HIV) screening remains low in many clinical practices despite published guidelines recommending screening for all patients between ages 13-65. Electronic clinical decision support tools have improved screening rates for many chronic diseases. A quality improvement project was designed to increase the rate of HIV screening of adult patients in a Midwest primary care Internal Medicine outpatient practice.

    Methods: Providers were initially surveyed and educated about current screening guidelines. 4 months of historical screening data were obtained. The intervention involved the addition of an HIV screen alert to the existing Generic Disease Management System (GDMS) to remind providers to screen eligible patients for HIV.  GDMS is an electronic clinical decision support tool designed by our institution, used to remind providers about recommended preventative services, including mammography, pap smear and colonoscopy. 6 months later, a post intervention survey was distributed to providers. Pre-intervention and post-intervention screening data were obtained from 1/1/14-4/30/14 and 5/1/14-12/31/14 respectively.

    Results: Of 148 providers surveyed, 64% of 68 providers responding did not screen all eligible patients for HIV; the most common reason cited was that they did not remember to discuss screening (52%). 25% of providers did not believe in screening "low risk" patients. There were 28036 appointments for 12596 unique patients eligible for HIV screening in 2014.  6070 and 6526 patients were seen prior to and after the GDMS alert intervention respectively.  In total, 327 patients were screened for HIV in 2014. 1.80% of eligible patients (18.0 per 1000 patient encounters) were screened prior to the GDMS alert intervention, and 3.34% of eligible patients (27.1 per 1000 patient encounters) were screened after the intervention. 31% of 36 providers responding to a post-intervention survey did not change their practice, but 72% indicated that they would be more likely to screen if the recommendation was viewable to patients also.

    Conclusion: This data showed that an electronic alert successfully improved by two-fold the rates of universal HIV screening by providers in primary care internal medicine.

    Jasmine Marcelin, MD1, Eugene Tan, MD2, Alberto Marcelin, MD3, Marianne Scheitel, .4, Praveen Ramu, .4, Ronald Hankey, .4, Pritesh Keniya, .4, Majken Wingo, MD4, Stacey Rizza, MD, FIDSA1, Frederick North, MD2 and Rajeev Chaudhry, MBBS, MPH4, (1)Infectious Diseases, Mayo Clinic, Rochester, MN, (2)Internal Medicine, Mayo Clinic, Rochester, MN, (3)Family Medicine, Mayo Clinic, Rochester, MN, (4)Mayo Clinic, Rochester, MN

    Disclosures:

    J. Marcelin, None

    E. Tan, None

    A. Marcelin, None

    M. Scheitel, None

    P. Ramu, None

    R. Hankey, None

    P. Keniya, None

    M. Wingo, None

    S. Rizza, None

    F. North, None

    R. Chaudhry, Mayo Clinic: Dr Chaudhry is an employee of Mayo Clinic and the inventor of GDMS software referenced in this abstract. , Mayo Clinic has licensed this technology to a commercial entity (VitalHealth Software) but to date has received no royalties. Dr Chaudhry receives no royalties from the licensing of this technology

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.