Central Implementation Strategies Outperform Local Ones in Improving HIV Testing in Veterans Healthcare Administration Facilities
Central Implementation Strategies Outperform Local Ones in Improving HIV Testing in Veterans Healthcare Administration Facilities
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DOI：
10.1007/s11606-013-2420-6
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发表时间：
2013-10-01
影响因子：
5.7
通讯作者：
Asch, Steven M.
中科院分区：
文献类型：
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作者：
Goetz, Matthew Bidwell;Tuyen Hoang;Asch, Steven M.
试点数据表明，多方面的方法可能会提高艾滋病毒检测率，但这种方法的可扩展性以及成功实施所需的支持水平仍然未知。评估扩大多成分干预措施在提高初级保健诊所基于风险和常规艾滋病毒诊断检测率方面的有效性以及不同水平项目支持的影响。三臂，准实验性实施研究研究。退伍军人健康管理局（VHA）设施。2009年6月至2011年9月期间接受初级保健的人员。在中央和地方研究中心实施了一项多模式方案，包括实时电子临床提醒，以促进艾滋病毒检测、提供者反馈报告和提供者教育;中央臂的研究中心也得到了持续的方案支助。在实施基于风险的临床提醒（I期）或常规临床提醒（II期）之前和之后的6个月内，对照组研究中心没有进行干预。基于风险的检测的调整率在对照组、当地组和中心组分别增加了0.4%、5.6%和10.1%（所有比较，p < 0.01）。在II期，对照组、局部组和中心组的常规检测校正率分别增加1.1%、6.3%和9.2%（所有比较，p < 0.01）。在研究结束时，70- 80%的患者接受了HIV检测。使用临床提醒、提供者反馈、教育和社会营销显著增加了VHA机构提供和进行HIV检测的频率。这些发现支持一种多模式方法，以实现让每个美国人都知道他们的艾滋病毒状况作为常规临床实践的目标。
Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown.To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support.Three arm, quasi-experimental implementation research study.Veterans Health Administration (VHA) facilities.Persons receiving primary care between June 2009 and September 2011A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no interventionFrequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II).The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). During phase II, the adjusted rate of routine testing increased by 1.1 %, 6.3 % and 9.2 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). At study end, 70-80 % of patients had been offered an HIV test.Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.