1905. Real-World Insights into Quality Improvement across 11 HIV Clinics in the US
Session: Poster Abstract Session: Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • ID Week Poster 2018 22x28 Poster_for upload.pdf (4.3 MB)
  • BackgroundAs people with HIV are living longer, focusing quality improvement (QI) initiatives on health maintenance and comprehensive patient-centered care is essential. This QI study evaluated chart-document performance in selected HIV care practices across the US.

     

    Methods: Participants were randomly selected from 11 Ryan White-funded HIV clinics in community (n=7), hospital (n=3) and academic (n=1) settings. At baseline, 200 consecutive charts (~20 per clinic) were reviewed for documentation of guideline-directed practices. Clinic teams participated in audit-feedback interventions to develop improvement plans. Three months later, consecutive charts were reviewed according to baseline methods. Chi-square tests were conducted to analyze pre- and post-intervention differences.

     

    Results: Significant improvements were seen in sexually transmitted infection (STI) screening, and patient counseling on sexual risk, pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART). Documentation of several health maintenance measures improved significantly.

     

    Conclusion: Audit-feedback of QI measures improved performance. This approach can inform future QI initiatives.

    Table. HIV Patient Characteristics and Percentages of Charts Documented for Quality Measures

     

    Baseline

    (n=200)

    Post Intervention

    (n=120)

    P-Value

    Demographic Characteristicsa

     

    Median years of age

    51

    40

    <.001

    Median years since HIV diagnosis

    18

    12

    <.001

    % female/male/transgender

    24/75/1

    16/84/0

    .054

    Sexual Health Assessment and HIV Prevention

     

    STI screening

    43

    64

    <.001

    Counseling on sexual risk

    22

    48

    <.001

    Counseling on PrEP for sexual partners

    11

    23

    .003

    Sexual partners prescribed PrEP

    9

    15

    .100

    Health Maintenance Assessment

     

    Glucose

    78

    91

    .003

    Transaminases

    77

    92

    .001

    Cardiovascular risk calculation

    71

    74

    .541

    Lipid profile

    59

    64

    .359

    25OH Vitamin D level

    16

    27

    .021

    Bone densitometry for patients >50 years

    7

    5

    .299

    Creatinine clearance

    15

    58

    <.001

    Shared Decision-Making

     

    Patient counseling on:

    ·         ART risks and benefits

    ·         Understanding ART

    ·         Exploring patients’ ART concerns

    ·         Opportunities for patients to ask questions

    53

    33

    31

    51

    66

    69

    46

    82

    .056

    <.001

    .008

    <.001

    aAnalyses for continuous and categorical variables based on Mann-Whitney U test and chi-square test, respectively

    David Alain Wohl, MD1, Cynthia Brinson, M.D.2, Charles Hicks, MD3, Peter Shalit, MD, PhD4, W. David Hardy, MD5, Jeffrey Carter, PhD6, Laura Simone, PhD6 and Tamar Sapir, PhD6, (1)Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, (2)Central Texas Clinical Research, Austin, TX, (3)University of California San Diego, La Jolla, CA, (4)Peter Shalit, MD, and Associates, Seattle, WA, (5)Clinical Investigations Department, Whitman-Walker Health, Washington, DC, (6)PRIME Education, LLC, Fort Lauderdale, FL

    Disclosures:

    D. A. Wohl, None

    C. Brinson, Gilead: Investigator , Scientific Advisor and Speaker's Bureau , Research support and Speaker honorarium . Theratech: Investigator , Research support . BMS: Investigator , Research support . SlieaGen: Investigator , Research support . GSK ViiV: Consultant , Investigator and Scientific Advisor , Consulting fee , Research support and Speaker honorarium . Daiichi Sankyo: Sub Investigator , Research support . Novo Nordisk: Investigator , Research support . Sanofi: Investigator , Research support . Watson: Investigator , Research support . Salix: Investigator , Research support . Janssen: Investigator , Research support . Roche: Investigator , Research support . Colucid: Investigator , Research support . Eisai: Investigator , Research support . Shionogi: Investigator , Research support . Elcelyx: Investigator , Research support . Sangamo: Sub Investigator , Research support .

    C. Hicks, ViiV Healthcare: Employee , Salary .

    P. Shalit, Gilead: Consultant , Investigator and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium . Viiv: Consultant and Speaker's Bureau , Consulting fee and Speaker honorarium . Janssen: Consultant , Investigator and Speaker's Bureau , Research support and Speaker honorarium . Merck: Speaker's Bureau , Speaker honorarium .

    W. D. Hardy, Gilead Sciences: Consultant and Investigator , Consulting fee and Research support . ViiV Healthcare: Consultant and Investigator , Consulting fee and Research support . Amgen: Investigator , Research support . Janssen: Investigator , Research support . Merck: Investigator , Research support .

    J. Carter, PRIME Education, LLC: Employee , Salary .

    L. Simone, PRIME Education, LLC: Employee , Salary .

    T. Sapir, PRIME Education, LLC: Employee , Salary . Gilead Sciences Inc.: Independent medical education provider , Educational grant .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.