Post on 20-Sep-2020
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.
ORGANIZATIONNew 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 DESCRIPTIONThe 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
INCREASETHE PROPORTION OF PATIENTS WHO ENTER CARE EARLY
PREVALENCE FY05-FY08
HIV POSITIVE UPT FY05-FY08
FACILITY TESTING TARGET VARIED FY06-FY08
PROPORTION OF ELIGIBLESTESTED 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 ANDLESSONS 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 CorporationE-mail: Terry.Hamilton@nychhc.orgPhone: 212-788-3604
November 2008
2 4 , 8 8 4
3 7 , 1 3 9
2 5 , 6 9 7
6 6 , 4 2 6
2 7 , 4 3 7
1 0 6 , 4 2 2
2 8 , 1 0 3
1 3 2 , 7 9 7
0
2 0 , 0 0 0
4 0 , 0 0 0
6 0 , 0 0 0
8 0 , 0 0 0
1 0 0 , 0 0 0
1 2 0 , 0 0 0
1 4 0 , 0 0 0
1 6 0 , 0 0 0
1 8 0 , 0 0 0
F Y 0 5 F Y 0 6 F Y 0 7 F Y 0 8
A l l U n i q u e P a t i e n t s T e s t e d - F Y 0 5 t h r o u g h F Y 0 8
P r e n a t a l U P T U P T
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
F Y 0 5 F Y 0 6 F Y 0 7 F Y 0 8
A l l U n i q u e P a t i e n t s T e s t e d - F Y 0 5 t h r o u g h F Y 0 8 R H T v C N
C N R H T
HIV TESTING PROGRESSFY05-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
7 2 0
1 5 1 4
1 6 3 0
1 8 6 3
0
2 0 0
4 0 0
6 0 0
8 0 0
1 0 0 0
1 2 0 0
1 4 0 0
1 6 0 0
1 8 0 0
2 0 0 0
F Y 0 5 F Y 0 6 F Y 0 7 F Y 0 8
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 %
2 0 . 0 %
4 0 . 0 %
6 0 . 0 %
8 0 . 0 %
1 0 0 . 0 %
1 2 0 . 0 %
1 4 0 . 0 %
1 6 0 . 0 %
FacilitiesFY06
FacilitiesFY07
FacilitiesFY08
Targ
et
FY0738.9% Met Or
Exceeded Target
FY 0866.7% Met Or
Exceeded Target
FY0627.8% 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 08Proportion of Eligible FY 05 through FY 08
720
1514
1630
1863