Patient-focused Interventions

Cornell University

Weill Medical College

At two hospital-based outpatient clinics in New York City that enroll patients in a Medicaid Special Needs Programs for people with HIV. There are 700 patients attending one of the clinics.

Computer work stations for patients in the clinic, using the following software:

A computerized patient questionnaire using an
ACASI (Audio Computer Assisted Self Interview) system

CERNER: Electronic Medical Record (patient access to limited medical record information)

Provides patients with the opportunity to confidentially complete surveys about treatment adherence, treatment side effects, substance use, and depression and to review quality of care information from their medical records (including simple summary of medical information in English or Spanish) prior to primary care visits. Both the patient and the provider receive reports.

Patient

To enhance shared decision making during the clinic visit

To improve patient outcomes and quality of care by identifying adherence problems and co-morbidities, and improving specialist referral patterns

To test the feasibility and cost-effectiveness in a Medicaid managed care environment

Johns Hopkins University (JHU)

AIDS Service

HIV Outcomes Program

At the JHU AIDS Service, an outpatient, hospital-based HIV primary care clinic in east Baltimore Maryland. There are 2,300 patients in the system.

Computer workstations for patients in the clinic using the following software:

A computerized patient questionnaire using an ACASI (Audio Computer Assisted Self Interview) system

Provides patients with a self-administered assessment about medical knowledge, treatment adherence, depression, substance use, and other sensitive topics that is completed at each primary care visit. A printout is given to the patient and the provider as the basis for discussion during the visit. Providers use the survey to obtain information for clinical decisions.

Patient

To enhance delivery of care and improve clinical outcomes by providing a tool for standard assessment of adherence to combination antiretroviral therapy

Provider-focused Interventions

Columbia University Center for Applied Public Health

(CAPH)

At 36 outpatient primary care clinics in New York, New Jersey, and the Midwest. The clinics serve a total of approximately 1,000 to 1,500 people with HIV.

HIV TIPS:
a web-based stand-alone interactive decision-support and information system

Provides clinicians with assistance at the point of care when formulating patient medication regimens.
Provides clinicians with medication adherence plan tailored to each patient's situation.
Sends tailored messages to providers to motivate use of the system.
Implementation begins with an IT needs assessment and participator design process to boost provider use by adapting access to the system to match agency patient flow and access to network computer.

Providers:
physicians, nurse practitioners, physician assistants, social workers, and health educators

To reduce prescription errors by improving prescribing behaviors of providers

To improve patient outcomes

Duke University

Health Inequalities Program

At 2 hospital-based infectious disease clinics, 6 community-based primary care HIV clinics, and 13 community-based case management agencies in central and eastern North Carolina. There are 7,700 patients in the system.

Provide:
Data management software with multiple databases, including medical records and case management; linked by a secure network housed at Duke University

Enables providers, specifically case managers in rural community settings and clinicians in centralized HIV clinics, to share information electronically about patients. Case managers administer medicine adherence questionnaires on laptop computers for clinicians to access in the clinic prior to making medical decisions.

Providers:
physicians, case managers

To improve quality of care by increasing communication among providers and providing them with access to patient information at geographically distant agencies.

Los Angeles Department of Health Services (DHS)

Public Health

 Office of AIDS Programs and Policy (OAPP)

At 40 community-based HIV counseling and testing (HCT) sites, 38 health centers, and 6 hospitals in LA County. Each year approximately 600 people test positive confidentially and 600 test positive anonymously.

HITS (HIV/AIDS Interface Technology System):
a web-based multi-user system that links HIV counseling and testing (HCT) services and HIV medical services

HIRS (HIV Information Resources System): a web-based, multi-user system that integrates information systems for management of HIV prevention, testing and treatment services

Provides HCT counselors with access to the HIV resource directory for LA County, a client data system for better client tracking, and electronic reminders if clients do not return for test results. Allows HCT and medical outpatient service providers to securely access client information across the system.

Providers: HCT counselors, case managers, health educators, social workers, nurse practitioners, physician assistants, physicians, and medical assistants

TTo increase the proportion of clients who return for HIV test results

To reduce the time from detection of HIV to enrollment in primary care

To facilitate client movement between HCT services and outpatient medical care

To enhance eligibility screening

Louisiana State University

Health Care Services Division (HCSD)

At the eight hospital-based HIV ambulatory care clinics throughout the state that serve over 5,500 people with HIV.

LabTracker:
an electronic patient database with linkages to receive patient information from hospital information systems and to allow provider input.

Enables providers to have immediate access to medical record information (patient demographics, financial and contact information, laboratory results, diagnoses, allergies, health maintenance procedures, immunizations, and medications). Access level varies according to provider role in the patient's care.

Creates educational materials and summary medical information for provider use with patients (eg, graph of viral load and CD4 response to medication, patient management report listing health information, test results and medications).

Providers:
physicians, nurse practitioners, nurses, mental health professionals, social workers, nutritionists, health educators, and substance abuse counselors

To improve delivery of HIV care by enhancing access to comprehensive information for clinical decision making

To provide aggregate data for CQI and disease management initiatives

To monitor trends in service delivery

To describe populations in care