1
INTEGRATION OF HIV TESTING WITHIN MEDICAL CARE IN A LARGE PUBLIC HOSPITAL SYSTEM Omi, Joanna , Senior Assistant Vice President of Corporate Planning and HIV Services/Chief Innovation Officer; Aberg MD, Judith, HIV Medical Director, Bellevue Hospital Center; Hamilton, Terry, Director, HIV Services, Corporate Planning and HIV Services; De Los Reyes, Andrew, Project Director, HIV Testing Expansion Initiative, Corporate Planning and HIV Services. ORGANIZATION New York City Health and Hospitals Corporation (HHC), the largest municipal healthcare system in the country, is a $5.4 bil- lion public benefit corporation serving 1.3 million New Yorkers annually, approximately 19,000 of whom have HIV/AIDS. Nearly 400,000 of HHC’s patient population are uninsured. HHC is comprised of: 11 acute care hospitals approved as New York State Designated AIDS Centers 6 diagnostic and treatment centers (D&TCs) 4 long-term care hospitals 95 extension clinics MetroPlus (health maintenance organization) Partnership in Care (HIV- specific managed care plan) Home care agency PROGRAM DESCRIPTION The availability of rapid HIV tests and treatment advances compelled HHC to increase efforts to bring patients into care as soon as possible post-infection. The HIV Testing Expansion Initiative is defined by the integration of HIV testing within multi- ple non-HIV specific venues, including inpatient med-surg units, outpatient primary and specialty care clinics and emer- gency departments. The Initiative has three goals: INCREASE THE NUMBER OF UNIQUE PATIENTS WHO KNOW THEIR HIV STATUS ONCE IN CARE - RETAIN PATIENTS IN CARE INCREASE THE PROPORTION OF PATIENTS WHO ENTER CARE EARLY PREVALENCE FY05-FY08 HIV POSITIVE UPT FY05-FY08 FACILITY TESTING TARGET VARIED FY06-FY08 PROPORTION OF ELIGIBLES TESTED FY05-FY08 DATA & FOOTNOTES UPT = unique patients tested. CN = conventional testing. RHT = rapid HIV testing. FY06-FY08 UPT are unique to the facility, and in some cases a regional network of HHC facilities, based on facility reporting for all areas. FY06-FY08 UPT are unique to each fiscal year based on facility reporting for all areas. FY05 UPT are OP and ED Pilot Sites only based on PLM (billing claims) data and Pilot Site reports. FY05 UPT are unique to the facility, and in some cases a regional network of HHC facilities and is based on PLM and ED Pilot Site reporting. FY05 UPT are unique to each fiscal year based on PLM data. FY05-FY08 unique prenatal HIV tests represent prenatal clinics only and are derived from the Siemens Data Warehouse. The total number of eligible patients refers to all unique patients 13 years old and older. Unless otherwise stated, the term “Testing” refers to HIV testing. The term “Diagnosis” refers to HIV diagnosis. OUTCOMES AND LESSONS LEARNED OUTCOMES Testing of eligible patients doubled from FY05 to FY08. The prevalence initially rose with the roll-out but has subsequently reached a plateau. The number of positive patients more than doubled, from 720 in FY05 to 1,863 in FY08. Of newly diagnosed patients with HIV and scheduled for a first primary care appointment, 73% in FY08 were seen in the same month of their diagnosis (509/698). LESSONS LEARNED Large-scale use of RHT is acceptable to patients and staff, as is conventional (CN) testing. Testing expansion can occur across multiple venues and specifically within the emergency department or inpatient services. In 3 years, an increasing number of facilities met or exceeded their annual facility HIV testing targets. ACKNOWLEDGEMENTS & CONTACT A heartfelt thank you to the physicians, nurses, patient care associates, counselors, phlebotomists, lab directors and all staff throughout HHC who have championed this effort. Special Acknowledgement goes to: Drew De Los Reyes, Project Director, HIV Testing Expansion Initiative, HHC Jay Gabor, Senior Management Consultant, HIV Services, HHC Contact: Terry Hamilton, Director, HIV Services, New York City Health and Hospitals Corporation E-mail: [email protected] Phone: 212-788-3604 November 2008 24,884 37,139 25,697 66,426 27,437 106,422 28,103 132,797 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 FY05 FY06 FY07 FY08 All Unique Patients Tested - FY05 through FY08 Prenatal UPT UPT 160,900 133,859 92,123 62,023 58,785 3,238 42,134 49,989 25,145 108,714 22,613 138,287 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 FY05 FY06 FY07 FY08 All Unique Patients Tested - FY05 through FY08 RHT v CN CN RHT HIV TESTING PROGRESS FY05-FY08 160,900 133,859 92,123 62,023 62,023 922,242 92,123 895,119 133,859 865,555 160,900 879,532 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 1,100,000 FY05 FY06 FY07 FY08 Proportion of Eligible - FY05 through FY08 UPT Elig not tested 6.3% 9.3% 13.4% 15.5% 1.08% 1.64% 1.22% 1.16% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8% 2.0% FY05 FY06 FY07 FY08 Prevalence - FY05 through FY08 720 1514 1630 1863 0 200 400 600 800 1000 1200 1400 1600 1800 2000 FY05 FY06 FY07 FY08 Proportion of UPT by Venue FY 08 67.2% 8.8% 24.0% Proportion of UPT by Venue FY 06 78.0% 8.4% 13.6% Outpatient Inpatient Emergency Dept. PROPORTION OF UPT BY VENUE FY06-FY08 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0% 140.0% 160.0% Facilities FY06 Facilities FY07 Facilities FY08 Target FY07 38.9% Met Or Exceeded Target FY 08 66.7% Met Or Exceeded Target FY06 27.8% Met Or Exceeded Target Proportion of UPT by Venue FY 07 68.7% 7.6% 23.7% Proportion of Unique Patients Tested by Venue FY 06 Proportion of Unique Patients Tested by Venue FY 07 Proportion of Unique Patients Tested by Venue FY 08 8.4% 13.6% 78.0% 23.7% 7.6% 68.7% 24.0% 8.8% 67.2% All Unique Patients Tested FY 05 through FY 08 RHT v CN All Unique Patients Tested FY 05 through FY 08 Number of HIV Positive Unique Patients Tested FY 05 through FY 08 Facility Testing Target Achievement FY 06 through FY 08 HIV Prevalence of Unique Patients Tested FY 05 through FY 08 Proportion of Eligible FY 05 through FY 08 720 1514 1630 1863
![[123doc.vn] hhc daicuong](https://static.documents.pub/doc/80x56/558fc9551a28ab970b8b4692/123docvn-hhc-daicuong.jpg)
