Uriel R Felsen1, Chinazo O Cunningham, Moonseong Heo, Donna C Futterman, Jeffrey M Weiss, Barry S Zingman. 1. *Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; †Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; and ‡Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
Abstract
BACKGROUND: Routine HIV testing of hospitalized patients is recommended, but few strategies to expand testing in the hospital setting have been described. We assessed the impact of an electronic medical record (EMR) prompt on HIV testing for hospitalized patients. METHODS: We performed a pre-post study at 3 hospitals in the Bronx, NY. We compared the proportion of admissions of patients 21-64 years old with an HIV test performed, characteristics of patients tested, and rate of new HIV diagnoses made by screening while an EMR prompt recommending HIV testing was inactive vs. active. The prompt appeared for patients with no previous HIV test or a high-risk diagnosis after their last HIV test. RESULTS: Among 36,610 admissions while the prompt was inactive, 9.5% had an HIV test performed. Among 18,943 admissions while the prompt was active, 21.8% had an HIV test performed. Admission while the prompt was active was associated with increased HIV testing among total admissions [adjusted odds ratio (aOR) 2.78, 95% confidence interval (CI): 2.62 to 2.96], those without a previous HIV test (aOR 4.03, 95% CI: 3.70 to 4.40), and those with a previous negative test (aOR 1.52, 95% CI: 1.37 to 1.68) (P < 0.0001 for all). Although the prompt was active, testing increased across all patient characteristics. New HIV diagnoses made by screening increased from 8.2/100,000 admissions to 37.0/100,000 admissions while the prompt was inactive and active, respectively (OR 4.51 95% CI: 1.17 to 17.45, P = 0.03). CONCLUSIONS: An EMR prompt for hospitalized patients was associated with a large increase in HIV testing, a diversification of patients tested, and an increase in diagnoses made by screening.
BACKGROUND: Routine HIV testing of hospitalized patients is recommended, but few strategies to expand testing in the hospital setting have been described. We assessed the impact of an electronic medical record (EMR) prompt on HIV testing for hospitalized patients. METHODS: We performed a pre-post study at 3 hospitals in the Bronx, NY. We compared the proportion of admissions of patients 21-64 years old with an HIV test performed, characteristics of patients tested, and rate of new HIV diagnoses made by screening while an EMR prompt recommending HIV testing was inactive vs. active. The prompt appeared for patients with no previous HIV test or a high-risk diagnosis after their last HIV test. RESULTS: Among 36,610 admissions while the prompt was inactive, 9.5% had an HIV test performed. Among 18,943 admissions while the prompt was active, 21.8% had an HIV test performed. Admission while the prompt was active was associated with increased HIV testing among total admissions [adjusted odds ratio (aOR) 2.78, 95% confidence interval (CI): 2.62 to 2.96], those without a previous HIV test (aOR 4.03, 95% CI: 3.70 to 4.40), and those with a previous negative test (aOR 1.52, 95% CI: 1.37 to 1.68) (P < 0.0001 for all). Although the prompt was active, testing increased across all patient characteristics. New HIV diagnoses made by screening increased from 8.2/100,000 admissions to 37.0/100,000 admissions while the prompt was inactive and active, respectively (OR 4.51 95% CI: 1.17 to 17.45, P = 0.03). CONCLUSIONS: An EMR prompt for hospitalized patients was associated with a large increase in HIV testing, a diversification of patients tested, and an increase in diagnoses made by screening.
Authors: Patrick S Sullivan; Michael S Lyons; Maggie Czarnogorski; Bernard M Branson Journal: Public Health Rep Date: 2016 Jan-Feb Impact factor: 2.792
Authors: Donna Futterman; Stephen Stafford; Paul Meissner; Michelle Lyle-Gassama; Arthur Blank; Lindsay DuBois; Jonathan Swartz Journal: Public Health Rep Date: 2016 Jan-Feb Impact factor: 2.792
Authors: Julie E Myers; Sarah L Braunstein; Colin W Shepard; Blayne H Cutler; Andrea R Mantsios; Monica M Sweeney; Benjamin W Tsoi Journal: J Acquir Immune Defic Syndr Date: 2012-09-01 Impact factor: 3.731
Authors: James W Galbraith; James H Willig; Joel B Rodgers; John P Donnelly; Andrew O Westfall; Kelly L Ross-Davis; Sonya L Heath Journal: Public Health Rep Date: 2016 Jan-Feb Impact factor: 2.792
Authors: Matthew Bidwell Goetz; Tuyen Hoang; Candice Bowman; Herschel Knapp; Barbara Rossman; Robert Smith; Henry Anaya; Teresa Osborn; Allen L Gifford; Steven M Asch Journal: J Gen Intern Med Date: 2008-05-02 Impact factor: 5.128
Authors: Nicola M Zetola; Carlos G Grijalva; Sarah Gertler; C Bradley Hare; Beth Kaplan; Teri Dowling; Grant Colfax; Mitchell H Katz; Jeffrey D Klausner Journal: PLoS One Date: 2008-07-02 Impact factor: 3.240
Authors: Xia Lin; Patricia M Dietz; Vanessa Rodriguez; Deborah Lester; Paloma Hernandez; Lisa Moreno-Walton; Grant Johnson; Michelle M Van Handel; Jacek Skarbinski; Christine L Mattson; Dale Stratford; Lisa Belcher; Bernard M Branson Journal: MMWR Morb Mortal Wkly Rep Date: 2014-06-27 Impact factor: 17.586
Authors: Jason Zucker; Benjamin Patterson; Tanya Ellman; Jacek Slowikowski; Susan Olender; Peter Gordon; Ellen A B Morrison; Magdalena E Sobieszczyk Journal: AIDS Patient Care STDS Date: 2018-11 Impact factor: 5.078
Authors: Daniel J Feller; Jason Zucker; Michael T Yin; Peter Gordon; Noémie Elhadad Journal: J Acquir Immune Defic Syndr Date: 2018-02-01 Impact factor: 3.731
Authors: Ellen A Almirol; Moira C McNulty; Jessica Schmitt; Rebecca Eavou; Michelle Taylor; Audra Tobin; Kimberly Ramirez; Nancy Glick; Madison Stamos; Stephanie Schuette; Jessica P Ridgway; David Pitrak Journal: AIDS Patient Care STDS Date: 2018-10 Impact factor: 5.078
Authors: Emanuel Krebs; Xiao Zang; Benjamin Enns; Jeong E Min; Czarina N Behrends; Carlos Del Rio; Julia C Dombrowski; Daniel J Feaster; Kelly A Gebo; Brandon D L Marshall; Shruti H Mehta; Lisa R Metsch; Ankur Pandya; Bruce R Schackman; Steffanie A Strathdee; Bohdan Nosyk Journal: J Infect Dis Date: 2020-09-02 Impact factor: 5.226