scholarly journals A Midwestern Academic HIV Clinic Operation during the COVID-19 Pandemic: Implementation Strategy and Preliminary Outcomes

2021 ◽  
Vol 20 ◽  
pp. 232595822110414
Author(s):  
Nada Fadul ◽  
Nichole Regan ◽  
Layan Kaddoura ◽  
Susan Swindells
Keyword(s):  
Implementation Strategy ◽  
Viral Suppression ◽  
Care Delivery ◽  
Baseline Data ◽  
Medical Visit ◽  
Visit Frequency

During the COVID-19 pandemic, HIV clinics had to transform care delivery for people with HIV (PWH). We developed a multifaceted telehealth implementation strategy and monitored number of out of care patients (OOC), medical visit frequency (MVF), gap in care (GiC) and viral suppression (VS), and compared measures to baseline data. Between April and October 2020, 1559 visits were scheduled; 328 (21%) were missed, and 63 (4%) were new to care. Of the remaining 1168 follow-up visits, 412 (35%) were telehealth visits. As of October 2020, there were 53 patients OOC, MVF was 55% and GiC was 24% compared to 34, 69% and 14% at baseline, respectively. Overall VS rate remained high at 93% (97% for telehealth and 91% for in-person visits, p = 0.0001). Our implementation strategy facilitated quick provision of telehealth to a third of PWH receiving care in our clinic. While MVF decreased and GiC increased, VS rates remained high.

scholarly journals Benchmarking HIV Quality Measures in the US OPERA HIV Cohort

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Robert Heglar ◽  
Rodney Mood ◽  
Julie L Priest ◽  
Kathy L Schulman ◽  
Gregory P Fusco
Keyword(s):  
Viral Suppression ◽  
Retention In Care ◽  
Quality Measures ◽  
Medical Visit ◽  
Visit Frequency ◽  
National Quality ◽  
The Us ◽  
Patient Outreach ◽  
Assess Quality ◽  
Improve Patient

Abstract Background Quality measures are effective tools to improve patient outreach, retention in care, adherence, and outcomes. This study benchmarks National Quality Forum–endorsed HIV quality measures in a US clinical cohort. Methods This observational study utilized prospectively captured data from the Observational Pharmaco-Epidemiology Research and Analysis (OPERA) database over 2014−2016 to assess quality measure achievement among patients with HIV in terms of medical visit frequency (#2079), medical visit gaps (#2080), viral suppression (#2082), and antiretroviral therapy (ART) prescriptions (#2083). The proportion of patients meeting each measure was calculated. Generalized estimating equations assessed trends in measure achievement. Results The OPERA sample included 23 059−42 285 patients with similar demographics and characteristics across measurement periods. Overall, 62%−66% of patients met the visit frequency measure (#2079), 81%−85% had no gaps between visits (#2080), 71%−73% achieved viral suppression (#2082), and 92%−94% were prescribed ART (#2083). The adjusted odds of achieving viral suppression and being prescribed ART increased over time by 3% and 19%, respectively, despite a significant decline in patient engagement (16% for #2079, 25% for #2080). Patients <30 years of age were significantly less likely to meet all measures than older patients (P < .0001), with particularly low levels of engagement. Measure achievement also varied by gender, ethnicity, region, and select clinical characteristics. Conclusions Despite gains in the rate of ART prescription and viral suppression, there remains room for improvement in the care of patients with HIV. Strategies for quality improvement may be more effective if tailored by age group.

scholarly journals 112. A Quality Management Project of a Midwestern Academic HIV Clinic Operation During COVID-19: Implementation Strategy and Preliminary Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S184-S185
Author(s):  
Nada Fadul
Keyword(s):  
Quality Management ◽  
Staff Training ◽  
Implementation Strategy ◽  
Care Delivery ◽  
Clinical Care ◽  
Retention In Care ◽  
Office Visits ◽  
Medical Visit ◽  
Viral Load Suppression ◽  
Management Project

Abstract Background During the COVID-19 pandemic, HIV clinics had to transform care delivery in order to ensure retention in care (RIC) for people with HIV (PWH). The objective of this quality management project is to maintain high rates of RIC and viral load suppression (VLS) during the pandemic for PWH receiving services at an academic HIV clinic in the Midwest. Methods We developed a multifaceted implementation strategy for clinic operation using a combination of telehealth and in-person visits. The strategy included: 1) assess for readiness and identify barriers and facilitators, 2) identify and prepare champions, 3) organize clinician implementation meetings, and 4) staff training. As a result, we developed an implementation blue print with criteria for telehealth vs. office visits, criteria for rescheduling patients, conducted staff training on telehealth and personal protective equipment, and changed the clinic structure to accommodate in-person visits for patients who did not meet telehealth criteria and walk-ins. We monitored VLS (defined as HIV RNA < 200 copies per mL) and RIC as measured by medical visit frequency (MVF, defined as percentage of patients who had one visit in each 6 months of the preceding 24 months with at least 60 days between visits); and gap in care (GiC, defined as no visit in the preceding 6 months). Results As of June 14, 2020, there were 1140 active PWH receiving care at the clinic. By February 29, 2020 there were 34 patients lost to care as (defined as no visit within the preceding 12 months). Between March 1 and June 14, 2020 we conducted a total 943 visits, out of which 642 (68%) were in person and 301 (32%) were telephone visits. By end of May 2020, there were 47 patients lost to care. MVF decreased to 40% compared to 69% for FY2020, and GiC increased to 25% compared to 14% for FY2020. VLS rate remained unchanged at 91%. Conclusion The COVID-19 pandemic resulted in a decrease in MVF and an increase in GiC for PWH. However, VLS remained high at 91%. Our implementation strategy facilitated quick adoption of telemedicine, which helped us provide clinical care to a third of PWH during the pandemic. Telemedicine provided a great tool for ensuring patients remain VLS. Evaluation of implementation outcomes including fidelity and reach remains ongoing. Disclosures All Authors: No reported disclosures

scholarly journals 483. OPAT Delivery during COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S308-S308
Author(s):  
Michael J Swartwood ◽  
Renae A Boerneke ◽  
Alan C Kinlaw ◽  
Nikolaos Mavrogiorgos ◽  
Ashley Marx ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Care Delivery ◽  
Clinical Care ◽  
Monitoring Program ◽  
Baseline Data ◽  
Readmission Rates ◽  
Team Members ◽  
Comparison Time ◽  
Clinic Visits

Abstract Background In 2020, COVID-19 spurred unprecedented change in the delivery of routine clinical care. The UNC OPAT program staff, previously accustomed to in-person collaboration in the hospital, became geographically distant amid North Carolina’s partial shutdown starting in March 2020. Team members relied on teleworking and many OPAT clinic visits shifted to phone and video telehealth. We assessed how COVID-19 impacted our care of OPAT patients including follow-up visits and readmissions. Methods UNC’s OPAT database contains clinical and demographic information on all patients on OPAT for at least 14 days who received specialized monitoring program led by an infectious diseases (ID) pharmacist, after evaluation by an ID physician. For all OPAT courses that ended between 3/1/20 and 5/20/20 (last available data cut), we assessed the length of OPAT treatment course, readmissions, adverse events, follow-up ID clinic visits, and the method of follow up visit utilized. We compared these measurements to historical baseline data from 3/1/19 to 5/20/19. Results During the 2020 period, 73 patients completed OPAT, with median OPAT enrollment lasting 36 days, which was similar to 2019 data (70 patients; median OPAT enrollment of 35 days). During the 2019 period, 93% of patients attended a follow up visit with an infectious diseases clinician, all of which took place in person. During the 2020 (COVID-19) period, 85% of patients attended an ID follow up visit; contrary to 2019, 42% of these visits took place in person, 45% were by phone and 13% were via a telemedicine video service. Readmission rates were similar across the two time periods (16% during COVID-19 vs 14% during 2019 comparison time period, P=0.72). Conclusion UNC OPAT continued through the emergence of COVID-19 as an essential service for a high patient volume by adapting its care delivery and follow-up visit protocols to include virtual care options. Readmission rates for OPAT patients during COVID-19 were comparable to historical baseline data. Disclosures All Authors: No reported disclosures

scholarly journals 878. Telemedicine Implementation in a Midwestern HIV Clinic: One Year Outcomes

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S531-S531
Author(s):  
Nichole N Regan ◽  
Laura Krajewski ◽  
Nada Fadul
Keyword(s):  
Viral Suppression ◽  
Implementation Process ◽  
Retention In Care ◽  
Hiv Care ◽  
Medical Visit ◽  
Viral Load Suppression ◽  
Poverty Level ◽  
Post Intervention ◽  
Safe Alternative

Abstract Background During the COVID-19 pandemic, we realized the importance of limiting in-clinic interactions with patients who were stable on antiretroviral therapy to promote social distancing. Our HIV clinic adopted telemedicine practices, in line with the HHS Interim Guidance for COVID-19 and Persons With HIV. Several HIV clinics reported lower viral suppression rates during the pandemic. We aim to describe the implementation process as well as year one outcomes of telemedicine at our clinic. Methods In March 2020, we created telemedicine protocols; we also designed and continuously updated algorithms for determining patient eligibility for telemedicine based on recent viral loads and last clinic visit. We monitored outcomes through electronic medical record chart reviews between May 1, 2020, and April 30, 2021. We collected patient demographics, and federal poverty level (FPL) information. We collected baseline and post-intervention rates of viral load suppression (VLS, defined as HIV RNA < 200 copies per mL), medical visit frequency (MVF, defined as percentage of patients who had one visit in each 6 months of the preceding 24 months with at least 60 days between visits) and lost to care (LOC, no follow up within 12 months period). Results We conducted a total of 2298 ambulatory medical visits; 1642 were in person and 656 (29%) were telemedicine visits. Out of those, 2177 were follow up visits (649, 30% telemedicine). There was no difference of telemedicine utilization based on race (28% in African Americans vs. 32% in Whites); ethnicity (30% in Hispanic vs. 30% in Hon-Hispanic); gender (24% in females vs. 30% in males); or FPL (28% in FPL < 200% vs. 31% in FPL >200%). By the end of April 2021, overall clinic VLS rate was 94%, MVF was 48%, and there were 40 patients LOC compared to 92%, 49%, and 43 patients in April 2020, respectively. Conclusion Telemedicine was a safe alternative to routine in-person HIV care during the COVID-19 pandemic. We observed similar rates of utilization across demographic and FPL status. Applying selection criteria, viral suppression and retention in care rates were not adversely impacted by shift to telemedicine modality. Disclosures All Authors: No reported disclosures

scholarly journals Participant education, spousal education and dementia risk in a diverse cohort of members of an integrated health care delivery system in Northern California

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e040233
Author(s):  
Paola Gilsanz ◽  
Elizabeth Rose Mayeda ◽  
Chloe W Eng ◽  
Oanh L Meyer ◽  
M Maria Glymour ◽  
...  
Keyword(s):  
Care Delivery ◽  
Health Indicators ◽  
Health Care Delivery System ◽  
College Degree ◽  
Dementia Risk ◽  
Education College ◽  
Race Ethnicity ◽  
Participant Education ◽  
Spousal Education

ObjectiveThe role of spousal education on dementia risk and how it may differ by gender or race/ethnicity is unknown. This study examines the association between one’s own education separate from and in conjunction with spousal education and risk of dementia.DesignCohort.SettingKaiser Permanente Northern California (KPNC), an integrated health care delivery system.Participants8835 members of KPNC who were aged 40–55, married and reported own and spousal education in 1964–1973.Primary outcome measureDementia cases were identified through medical records from 1 January 1996 to 30 September 2017.MethodsOwn and spousal education was self-reported in 1964–1973 and each was classified as four indicator variables (≤high school, trade school/some college, college degree and postgraduate) and as ≥college degree versus <college degree. Age as timescale weighted Cox proportional hazard models adjusted for demographics and health indicators evaluated associations between participant education, spousal education and dementia risk overall and by gender and race/ethnicity.ResultsThe cohort was 37% non-white, 46% men and 30% were diagnosed with dementia during follow-up from 1996 to 2017 (mean follow-up=12.7 years). Greater participant education was associated with lower dementia risk independent of spousal education, demographics and health indicators. Greater spousal education was associated with lower dementia adjusting for demographics but became non-significant after further adjustment for participant education. The same pattern was seen for spousal education ≥college degree (not adjusting for participant education HRspousal education≥college degree=0.83 (95% CI: 0.76 to 0.90); adjusting for participant education HRspousal education≥college degree=0.92 (95% CI: 0.83 to 1.01)). These associations did not vary by gender or race/ethnicity.ConclusionIn a large diverse cohort, we found that higher levels of participant’s own education were associated with lower dementia risk regardless of spousal education. An inverse association between spousal education and dementia risk was also present, however, the effects became non-significant after adjusting for participant education.

scholarly journals Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Peru

2021 ◽  
pp. 095646242110240
Author(s):  
Genesis S Huerta-Vera ◽  
Manuel A Amarista ◽  
Fernando A Mejía ◽  
Ana B Graña ◽  
Elsa V Gonzalez-Lagos ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Clinical Situation ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Sectional Study ◽  
Cross Sectional ◽  
Epidemiological Trends ◽  
Clinical Conditions ◽  
Living With Hiv

Due to a huge crisis extensive to health services many Venezuelan people living with HIV (PLWH) had migrated abroad, including Peru where favorable laws were in place until June 2019. We describe the health status and epidemiological trends of PLWH from Venezuela at an HIV program in Lima. We analyzed baseline and follow-up data of all Venezuelan PLWH enrolled in our HIV program from January 2017 to December 2019. A cross-sectional study in a subsample served to describe ARV adherence and context of migration. Between 2017-2019 our HIV Program registered 398 Venezuelan PLWH, representing 20% of the 2018 annual enrollments; numbers decreased since mid-2019. The median age was 30 years (IQR 26;37) and 90.5% were men. Between 2017 and 2019, the proportion with diagnosis in Peru increased from 14.3% to 60.9%; of AIDS stage at entry, from 8.8% to 27.2%. By December 2019, 182/250 (72.8%) were still in care, and 43 (10.8%) had not started ART. Viral suppression evaluated in 195, was achieved in 71.8%. From 2017 to 2019, migrant PLWH arrived in worsened clinical conditions, with increasing diagnosis in Peru; the flow of migrant PLWH entering care diminished with less favorable laws. Viral suppression rates were suboptimal.

Mammography Surveillance and Mortality in Older Breast Cancer Survivors

2007 ◽  
Vol 25 (21) ◽  
pp. 3001-3006 ◽  
Author(s):  
Timothy L. Lash ◽  
Matthew P. Fox ◽  
Diana S.M. Buist ◽  
Feifei Wei ◽  
Terry S. Field ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Mortality ◽  
Breast Cancer Survivors ◽  
Care Delivery ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Stage I ◽  
Early Stage Disease

Purpose There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up. Patients and Methods We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality. Results One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group. Conclusion Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.

scholarly journals Implementing a Data to Care Strategy to Improve Health Outcomes for People With HIV: A Report From the Care and Prevention in the United States Demonstration Project

2018 ◽  
Vol 133 (2_suppl) ◽  
pp. 60S-74S ◽  
Author(s):  
Patricia Sweeney ◽  
Tamika Hoyte ◽  
Mesfin S. Mulatu ◽  
Jacquelyn Bickham ◽  
Antoine D. Brantley ◽  
...  
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Medical Care ◽  
Treatment Adherence ◽  
Viral Suppression ◽  
The United States ◽  
Health Departments ◽  
State Health ◽  
Improve Health

Objectives: The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia. Methods: The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services. Results: Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression. Conclusions: The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality.

scholarly journals EPID-16. INTEGRATION OF EHR AND CANCER REGISTRY DATA TO CONSTRUCT A PEDIATRIC NEURO-ONCOLOGY SURVIVORSHIP COHORT AND IMPROVE LONG-TERM FOLLOW-UP CARE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii322-iii322
Author(s):  
David Noyd ◽  
Claire Howell ◽  
Kevin Oeffinger ◽  
Daniel Landi ◽  
Kristin Schroeder
Keyword(s):  
Cancer Registry ◽  
Late Effects ◽  
Care Delivery ◽  
Clinic Visit ◽  
Registry Data ◽  
Cancer Registry Data ◽  
Significant Difference ◽  
Race Ethnicity

Abstract BACKGROUND Pediatric neuro-oncology (PNO) survivors suffer long-term physical and neurocognitive morbidity. Comprehensive care addressing late effects of brain tumors and treatment in these patients is important. Clinical guidelines offer a framework for evaluating late effects, yet lack of extended follow-up is a significant barrier. The electronic health record (EHR) allows novel and impactful opportunities to construct, maintain, and leverage survivorship cohorts for health care delivery and as a platform for research. METHODS This survivorship cohort includes all PNO cases ≤18-years-old reported to the state-mandated cancer registry by our institution. Data mining of the EHR for exposures, demographic, and clinical data identified patients with lack of extended follow-up (&gt;1000 days since last visit). Explanatory variables included age, race/ethnicity, and language. Primary outcome included date of last clinic visit. RESULTS Between January 1, 2013 and December 31, 2018, there were 324 PNO patients reported to our institutional registry with ongoing analysis to identify the specific survivorship cohort. Thirty patients died with an overall mortality of 9.3%. Two-hundred-and-sixteen patients were seen in PNO clinic, of which 18.5%% (n=40) did not receive extended follow-up. Patients without extended follow-up were an average of 3.5 years older up (p&lt;0.01); however, there was no significant difference in preferred language (p=0.97) or race/ethnicity (p=0.57). CONCLUSION Integration of EHR and cancer registry data represents a feasible, timely, and novel approach to construct a PNO survivorship cohort to identify and re-engage patients without extended follow-up. Future applications include analysis of exposures and complications during therapy on late effects outcomes.

eHealth in cardiac rehabilitation

2020 ◽  
pp. 171-176
Author(s):  
Ines Frederix ◽  
Paul Dendale
Keyword(s):  
Cardiac Rehabilitation ◽  
Progress Monitoring ◽  
Care Delivery ◽  
Cost Effective ◽  
Daily Practice ◽  
Point Of View ◽  
Successful Implementation ◽  
Sustained Delivery ◽  
Definition Of

TeleCR is an innovative and (cost-)effective preventive care delivery strategy that can overcome the challenges associated with traditional centre-based cardiac rehabilitation (CR). This chapter describes how it can be implemented in daily practice. From an organizational point of view, it implies a shift in traditional and operational workflows and reorganization of the (non-)human resources for care delivery. The establishment of a well-coordinated tele-team, the definition of clear goals, profound progress monitoring and follow-up, and the creation of an environment that promotes sustained delivery of teleCR are paramount. Tackling the current legal and technological challenges is another prerequisite for successful implementation.

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