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

Consulting New Solutions, Inc., 317 George Street, Suite 412, New Brunswick, NJ 08901, United States. Electronic address: .
International Journal of Medical Informatics (Impact Factor: 2). 08/2012; 81(10):e39-45. DOI: 10.1016/j.ijmedinf.2012.06.006
Source: PubMed


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.
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.
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.
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.

4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The success of antiretroviral therapy has led some people to now ask whether the end of AIDS is possible. For patients who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life. Treatment does not fully restore immune health; as a result, several inflammation-associated or immunodeficiency complications such as cardiovascular disease and cancer are increasing in importance. Cumulative toxic effects from exposure to antiretroviral drugs for decades can cause clinically-relevant metabolic disturbances and end-organ damage. Concerns are growing that the multimorbidity associated with HIV disease could affect healthy ageing and overwhelm some health-care systems, particularly those in resource-limited regions that have yet to develop a chronic care model fully. In view of the problems inherent in the treatment and care for patients with a chronic disease that might persist for several decades, a global effort to identify a cure is now underway.
    The Lancet 10/2013; 382(9903). DOI:10.1016/S0140-6736(13)61809-7 · 45.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sexually transmitted infections (STIs) are common and costly, in part because they are asymptomatic and result in serious complications. Primary care clinicians can easily diagnose and effectively treat most STIs. Clinicians should screen patients for STIs based on high-risk behaviors, and consult with local public health officials to adapt national screening guidelines to local epidemiology. Clinical encounters involving STI screening are opportunities to counsel patients on risk behaviors, and vaccinate against human papillomavirus and hepatitis B. Electronic health records and mobile phone apps show promise for improving the clinical care of STIs.
    Primary care 06/2014; 41(2):215-237. DOI:10.1016/j.pop.2014.02.003 · 0.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine approaches being used to evaluate and improve quality of HIV clinical services we searched the MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases for articles and abstracts focused on evaluating or improving quality of HIV clinical services. We extracted country income level, targeted clinical services, and quality evaluation approaches, data sources, and criteria. Fifty journal articles and 46 meeting abstracts were included. Of the 96 studies reviewed, 65% were programme evaluations, 71% focused on low- and middle-income countries, and 65% focused on antiretroviral therapy services. With regard to quality, 45% used a quality improvement model or programme, 13% set a quality threshold, and 51% examined patient records to evaluate quality. No studies provided a definition for quality HIV care. Quality assurance and improvement of HIV clinical services is increasingly important. This review highlights gaps in knowledge for future research, and may also help countries and programmes develop their HIV care quality improvement frameworks.
    International Journal of STD & AIDS 07/2014; 26(7). DOI:10.1177/0956462414543938 · 1.05 Impact Factor
Show more