An expanded HIV testing strategy leveraging the electronic medical record uncovers undiagnosed infection among hospitalized patients

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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 three 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 prior 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 (aOR 2.78, 95%CI 2.62-2.96), those without a prior HIV test (aOR 4.03 95%CI 3.70-4.40), and those with a prior negative test (aOR 1.52, 95%CI 1.37-1.68) (p<0.0001 for all). While 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 1.17-17.45, 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.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
DOIs
StateAccepted/In press - Jan 30 2017

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Electronic Health Records
HIV
Infection
Patient Admission

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

@article{bbbc1490040e496483f16f006b0e2c40,
title = "An expanded HIV testing strategy leveraging the electronic medical record uncovers undiagnosed infection among hospitalized patients",
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 three 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 prior 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 (aOR 2.78, 95{\%}CI 2.62-2.96), those without a prior HIV test (aOR 4.03 95{\%}CI 3.70-4.40), and those with a prior negative test (aOR 1.52, 95{\%}CI 1.37-1.68) (p<0.0001 for all). While 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 1.17-17.45, 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.",
author = "Felsen, {Uriel R.} and Cunningham, {Chinazo O.} and Moonseong Heo and Futterman, {Donna C.} and Weiss, {Jeffrey M.} and Zingman, {Barry S.}",
year = "2017",
month = "1",
day = "30",
doi = "10.1097/QAI.0000000000001299",
language = "English (US)",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",

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TY - JOUR

T1 - An expanded HIV testing strategy leveraging the electronic medical record uncovers undiagnosed infection among hospitalized patients

AU - Felsen, Uriel R.

AU - Cunningham, Chinazo O.

AU - Heo, Moonseong

AU - Futterman, Donna C.

AU - Weiss, Jeffrey M.

AU - Zingman, Barry S.

PY - 2017/1/30

Y1 - 2017/1/30

N2 - 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 three 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 prior 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 (aOR 2.78, 95%CI 2.62-2.96), those without a prior HIV test (aOR 4.03 95%CI 3.70-4.40), and those with a prior negative test (aOR 1.52, 95%CI 1.37-1.68) (p<0.0001 for all). While 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 1.17-17.45, 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.

AB - 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 three 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 prior 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 (aOR 2.78, 95%CI 2.62-2.96), those without a prior HIV test (aOR 4.03 95%CI 3.70-4.40), and those with a prior negative test (aOR 1.52, 95%CI 1.37-1.68) (p<0.0001 for all). While 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 1.17-17.45, 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.

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U2 - 10.1097/QAI.0000000000001299

DO - 10.1097/QAI.0000000000001299

M3 - Article

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

ER -