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退伍军人健康管理局中一项增加艾滋病毒检测干预措施的可推广性。

Exportability of an intervention to increase HIV testing in the Veterans Health Administration.

作者信息

Goetz Matthew Bidwell, Hoang Tuyen, Knapp Herschel, Henry S Randal, Anaya Henry, Chou Ann F, Gifford Allen L, Asch Steven M

机构信息

VA Greater Los Angeles Healthcare System, Los Angeles, USA.

出版信息

Jt Comm J Qual Patient Saf. 2011 Dec;37(12):553-9. doi: 10.1016/s1553-7250(11)37071-7.

Abstract

BACKGROUND

Exportability, or the dissemination of successful health services interventions from one site to another, must be demonstrated before systemwide implementation.

METHODS

The effectiveness of a previously successful multicomponent intervention to increase rates of HIV testing in Veterans Health Administration (VHA) health care facilities among those without records of previous testing was evaluated in two other VHA facilities. Whereas the principle responsibility for the provider-activation component of the intervention was previously borne by research staff, nonresearch staff now took on these responsibilities.

RESULTS

The annual rate of HIV testing among persons with documented risk factors for acquiring HIV infection increased by 5.8% and 16% after the end of the first year of implementation for the sites to which the project was newly exported and where nonresearch staff were responsible for implementation. In contrast, for the original implementation sites, where research staff played a major role in implementation, testing rates increased by 9.3% and 12.4%. There was no change in the rate of testing at a control site. At one site, HIV testing rates increased before implementation of the provider activation aspect of the intervention program.

CONCLUSIONS

An intervention to increase HIV testing rates, which combines informatics, organizational support, and provider activation, can be successfully exported and implemented by nonresearch staff and may not require an extensive provider activation program. The resultant increases in HIV testing are similar to those seen in facilities where research staff play an active role. This work provides support for further efforts to refine this program to promote non-risk-based testing for HIV infection, as per current VHA policy and to more broadly implement this program.

摘要

背景

在全系统实施之前,必须证明可推广性,即成功的卫生服务干预措施能否从一个地点推广到另一个地点。

方法

在另外两家退伍军人健康管理局(VHA)医疗机构中,评估了一项先前成功的多组分干预措施在无既往检测记录的人群中提高HIV检测率的效果。此前,干预措施中提供者激活部分的主要责任由研究人员承担,而现在由非研究人员承担这些责任。

结果

在新引入该项目且由非研究人员负责实施的地点,实施第一年年末后,有记录的HIV感染风险因素人群的年度HIV检测率分别提高了5.8%和16%。相比之下,在由研究人员在实施中发挥主要作用的原实施地点,检测率分别提高了9.3%和12.4%。对照地点的检测率没有变化。在一个地点,HIV检测率在干预项目的提供者激活方面实施之前就有所提高。

结论

一项结合信息学、组织支持和提供者激活的提高HIV检测率的干预措施,可以由非研究人员成功推广和实施,可能不需要广泛的提供者激活计划。由此导致的HIV检测率提高与研究人员发挥积极作用的机构中观察到的情况相似。这项工作为进一步完善该项目以促进按照当前VHA政策进行基于非风险的HIV感染检测以及更广泛地实施该项目的努力提供了支持。

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