1905. Real-World Insights into Quality Improvement across 11 HIV Clinics in the United States

Abstract

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 United States.MethodsParticipants 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.ResultsSignificant 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.ConclusionAudit-feedback of QI measures improved performance. This approach can inform future QI initiatives.Table:HIV Patient Characteristics and Percentages of Charts Documented for Quality MeasuresBaseline (n = 200)Post-Intervention (n = 120) P-valueDemographic characteristicsaMedian years of age5140<0.001Median years since HIV diagnosis1812<0.001% female/male/transgender24/75/116/84/00.054Sexual Health Assessment and HIV PreventionSTI screening4364<0.001Counseling on sexual risk2248<0.001Counseling on PrEP for sexual partners11230.003Sexual partners prescribed PrEP9150.100Health Maintenance AssessmentGlucose78910.003Transaminases77920.001Cardiovascular risk calculation71740.541Lipid profile59640.35925OH Vitamin D level16270.021Bone densitometry for patients >50 years750.299Creatinine clearance1558<0.001Shared Decision-MakingPatient counseling on ART risks and benefits53660.056 Understanding ART3369<0.001 Exploring patients’ ART concerns31460.008 Opportunities for patients to ask questions5182<0.001 aAnalyses for continuous and categorical variables based on Mann–Whitney U test and chi-square test, respectivelyDisclosures 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.