Electronic health information technology as a tool for improving quality of care and health outcomes for HIV/AIDS patients.

PURPOSE

This paper presents research on the interplay of health information technology (HIT), quality improvement and progression of health status. The purpose of the research was to determine whether electronic exchange of health information impacts quality of care and, by extension, health outcomes of patients with HIV/AIDS. The research was supported as a demonstration project under the Information Technology Networks of Care Initiative sponsored by the U.S. Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance (SPNS). The City of Paterson, New Jersey, Department of Health and Human Services administered the project as the grant recipient, secured and managed through the City of Paterson's Ryan White Part A Program of Bergen and Passaic Counties.

METHODS

We implemented a web-based health information support system, e2, to facilitate rigorous quality improvement activities associated with care and treatment of HIV/AIDS patients. We used e2 to monitor patient care in the clinic setting. We observed five quality and two health status indicators relating to the care of 263 HIV/AIDS medical patients at three HIV/AIDS medical clinics from 2008 to 2010. The quality indicators conformed to HIV/AIDS Bureau (HAB) Groups 1 and 2 definitions of two or more CD4 T-cell counts performed in the measurement year, AIDS patients prescribed HAART, two or more medical visits in the measurement year, PCP prophylaxis administered to AIDS patients with CD4 T-cell counts <200, and adults screened for syphilis within the measurement year. CD4 T-cell count and viral load suppression indicators were used as health status indicators. Frequency analysis and logistic generalized estimating equations were used to assess correlation. We also assessed user satisfaction with e2 as a quality improvement tool using qualitative methods.

RESULTS

Availability of the e2 system was a leading contributing factor in successful quality management activities, leading to improved quality of care and health status of HIV/AIDS patients across all three clinics. Significant improvements were observed in three of the five quality indicators and in both of the two health status indicators.

CONCLUSIONS

We conclude that health information technology as a tool for rigorous application of quality improvement methods can positively impact quality of care and health outcomes. We found that health outcomes improved over time when quality improvement methods were initiated and facilitated by a responsive electronic information support system.