UTILIZING CLINICAL DECISION SUPPORT SYSTEM ALERTS TO RETAIN PLHIV IN CARE IN CHARLOTTE, NC
Background
Clinical decision support system (CDSS) alerts may help retain people living with HIV (PLHIV) in care. A system of CDSS alerts utilizing the CHORUS™ portal in the OPERA Cohort was developed to identify PLHIV at risk of being lost to care. To evaluate feasibility for a larger scale study, a before and after implementation research pilot study was implemented in the OPERA Cohort at three clinic sites in Charlotte, NC.
(N or % of PLWH) |
Site A |
Site B |
Site C |
|||
Before |
After |
Before |
After |
Before |
After |
|
| Participants1 |
10,220 | 9,926 | 538 | 723 | 1,202 | 1,113 |
| Alerts / Responses | --- | 2,245 / 189 | --- | 756 / 334 | --- | 1,202 / 896 |
| Ratio of Alerts to Responses | --- | 11.9 | --- | 2.2 | --- | 1.5 |
| >1 Visit with Healthcare Provider | 46% | 46% | 91% | 80% | 72% | 81% |
| >2 Visits with Healthcare Provider | 41% | 41% | 85% | 74% | 64% | 72% |
Design
This project follows a design to assess the pre- and post-baseline “kept appointment rate”. A sample of patients with ≥1 visit (identified as 1 viral load and/or 1 CD4 count) in 12 months pre- and post-baseline/alert initiation, and patients with ≥2 visits (identified as 2 viral loads and/or 2 CD4 counts) in 12 months pre- and post-baseline/alert initiation. Participants were from three diverse clinics in Charlotte, North Carolina. For all patients, interactive alerts were displayed on staff’s private CHORUS portal page. Patients identified as high risk to loss of follow-up were summarized in bi-weekly emails with the CHORUS portal link.
Primary objective
- Assess if the clinical prompts can decrease missed visits within a clinic and increase retention in care.
Results
- Clinical decision support system alerts successfully implemented in CHORUS™ clinical reporting portal, despite suboptimal engagement at some sites
- Clinic with dedicated site staff and consistent utilization of alerts experienced improvement in retention of PLWH at-risk of falling out of care
Collaborators
Rodney Mood
Dr. Michael Leonard
Setting
Three diverse infectious disease clinics
Location
U.S.A.
Duration
Jul 2018 - Oct 2019
Category
Retention in Care and Adherence
Key study materials
RELATED STUDIES
USA
As part of an effort to re-engage patients into care, this study determined the effectiveness of using an outreach nurse as a direct clinical liaison through the State Bridge Counsellor (SBC) Program.
USA
As part of this project, financial incentives were used to engage and retain people living with HIV with the goal of contributing to viral suppression in the Baton Rouge, LA area.
ITALY
The RELAPP study is focused upon developing an algorithm for general practitioners in Italy to identify earlier those at risk of HIV.
NP-GBL-HVU-WCNT- 210058 | March 2022
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