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. 2014 Mar 26;5(1):299-312.
doi: 10.4338/ACI-2013-09-RA-0075. eCollection 2014.

An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV

R Schnall  1 , N Liu  2 , J Sperling  3 , R Green  4 , S Clark  3 , D Vawdrey  5
Affiliations

An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV

R Schnall et al. Appl Clin Inform. .

Abstract

Objective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13-64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.

Methods: During the pre-intervention period (2.5-4 months), an electronic "HIV Testing" order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.

Results: The percentage of visits where an HIV test was performed increased from 5.4% in the preintervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).

Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.

Keywords: HIV testing; electronic alert; electronic order set; screening test.

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Conflict of interest statement

Conflicts Of Interest

None of the listed authors have any financial or personal relationships with other people or organizations that may inappropriately influence or bias the objectivity of submitted content and/or its acceptance for publication in this journal.

Figures

Fig. 1
Fig. 1
Electronic HIV Testing Order Set
Fig. 2
Fig. 2
HIV Testing Alert
See this image and copyright information in PMC

References

    1. CDC US HIV/AIDS Surveillance Report, 2007. Atlanta: Centers for Disease Control and Prevention, 2009
    1. Centers for Disease Control and Prevention (CDC) HIV and AIDS in the United States 2011. Available from:http://www.cdc.gov/hiv/resources/factsheets/us.htm
    1. Schackman BR, et al. Cost-effectiveness implications of the timing of antiretroviral therapy in HIV-infected adults. Arch Intern Med. 2002; 162(21): 2478–2486 doi: ioi10799 [pii]. PubMed PMID: 12437408 - PubMed
    1. Paltiel AD, et al. Expanded screening for HIV in the United States--an analysis of cost-effectiveness. N Engl J Med 2005; 352(6): 586–595 doi: 352/6/586 [pii] 10.1056/NEJMsa042088. PubMed PMID: 15703423 - PubMed
    1. The White House Office of National AIDS Policy National HIV/AIDS Strategy for the United States. 2010

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