Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA.
AIDS Patient Care STDS. 2022 Mar;36(3):106-114. doi: 10.1089/apc.2021.0225.
Efforts to end the HIV and hepatitis C virus (HCV) epidemics begin with ascertainment of a person's infection status through screening. Despite its importance as a site of testing, missed opportunities for screening in the Emergency Department (ED) are common. We describe the impact of implementing an individualized provider feedback intervention on HIV and HCV testing in a quaternary ED. We conducted an interrupted time series analysis to evaluate the impact of the intervention on weekly HIV and HCV screening in an observational cohort of patients seeking care in the ED. The intervention included a physician champion individualized feedback with peer comparisons to all providers in the ED and an existing HIV/HCV testing and response team. Data were abstracted from the electronic medical record (EMR) for 30 weeks before, during, and after implementing the intervention. We used Poisson regression analysis to estimate changes in the weekly counts and rates of HIV and HCV testing. The incidence rate ratios (IRRs) of HIV testing were 1.94 [95% confidence interval (CI) 1.85-2.04] and 1.38 (95% CI 1.31-1.45) times higher for the intervention and post-intervention period compared with the pre-intervention period. The IRRs of HCV testing was 6.96 (95% CI 6.40-7.58) and 4.70 (95% CI 4.31-5.13) for the intervention and post-intervention periods. There were no meaningful differences in demographic characteristics during the observation period. The intervention meaningfully increased HIV and HCV testing volume and positive case detection, including testing in high-risk groups like young adults and individuals without prior testing. Although diminished, the intervention effect sustained in the 30-week period following implementation.
消除艾滋病毒和丙型肝炎病毒（HCV）疫情的努力始于通过筛查确定一个人的感染状况。尽管急诊部门（ED）作为检测场所非常重要，但在 ED 错过筛查机会的情况很常见。我们描述了在一家四级 ED 实施个体化提供者反馈干预措施对艾滋病毒和 HCV 检测的影响。我们进行了一项中断时间序列分析，以评估该干预措施对 ED 就诊患者观察队列中每周 HIV 和 HCV 筛查的影响。该干预措施包括向所有 ED 医务人员提供医生冠军的个体化反馈，并与同行进行比较，以及现有的艾滋病毒/HCV 检测和反应团队。从电子病历（EMR）中提取 30 周的干预前、干预中和干预后的数据。我们使用泊松回归分析估计每周 HIV 和 HCV 检测的计数和比率的变化。与干预前相比，干预期间和干预后 HIV 检测的发病率比（IRR）分别为 1.94（95%CI 1.85-2.04）和 1.38（95%CI 1.31-1.45）。干预期间和干预后 HCV 检测的 IRR 分别为 6.96（95%CI 6.40-7.58）和 4.70（95%CI 4.31-5.13）。在观察期间，人口统计学特征没有明显差异。该干预措施显著增加了 HIV 和 HCV 检测量和阳性病例检出率，包括对年轻人和无既往检测史等高危人群的检测。尽管干预效果有所减弱，但在实施后的 30 周内仍持续存在。
