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

Abstract

Background

As 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.

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	<0.001
Median years since HIV diagnosis	18	12	<0.001
% female/male/transgender	24/75/1	16/84/0	0.054
Sexual Health Assessment and HIV Prevention
STI screening	43	64	<0.001
Counseling on sexual risk	22	48	<0.001
Counseling on PrEP for sexual partners	11	23	0.003
Sexual partners prescribed PrEP	9	15	0.100
Health Maintenance Assessment
Glucose	78	91	0.003
Transaminases	77	92	0.001
Cardiovascular risk calculation	71	74	0.541
Lipid profile	59	64	0.359
25OH Vitamin D level	16	27	0.021
Bone densitometry for patients >50 years	7	5	0.299
Creatinine clearance	15	58	<0.001
Shared Decision-Making
Patient counseling on
ART risks and benefits	53	66	0.056
Understanding ART	33	69	<0.001
Exploring patients’ ART concerns	31	46	0.008
Opportunities for patients to ask questions	51	82	<0.001

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

Disclosures

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.

Session: 225. Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis

Saturday, October 6, 2018: 12:30 PM