Using HIV Surveillance Laboratory Data to Identify Out-of-Care Patients
Using HIV Surveillance Laboratory Data to Identify Out-of-Care Patients
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DOI：
10.1007/s10461-017-1742-5
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发表时间：
2019-01-01
影响因子：
4.4
通讯作者：
Cranston, Kevin
中科院分区：
文献类型：
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作者：
Hague, John Christian;John, Betsey;Cranston, Kevin
向公共卫生监测报告的艾滋病毒相关实验室检测结果已被用作衡量艾滋病毒阳性者护理参与情况的替代指标。作为卫生资源和服务管理局（HRSA）国家意义特别项目（SPNS）倡议的一部分，马萨诸塞州公共卫生部（MDPH）与三个试点临床设施合作，以确定最后一次HIV实验室检测发生在参与设施但随后似乎失去护理的HIV+患者，定义为至少6个月没有向MDPH报告艾滋病毒实验室检测结果。然后，临床机构审查医疗记录，以确定这些患者是否实际上没有得到护理，或者是否有其他原因导致他们没有进行实验室检查，并向MDPH提供关于每个假定的护理外患者的反馈。在试点项目的第一年，37%的患者根据实验室数据似乎是脱离护理的，在审查临床健康记录后被证实是脱离护理的。在那些被确认脱离护理的患者中，55%在3个月内进行了后续实验室检查，72%在6个月内进行了实验室检查，这表明他们已经重新与护理提供者接触。MDPH发现，根据监测数据，临床工作人员必须确认被认为是脱离护理的患者的护理状况。
HIV-associated laboratory tests reported to public health surveillance have been used as a proxy measure of care engagement of HIV+ individuals. As part of a Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Initiative, the Massachusetts Department of Public Health (MDPH) worked with three pilot clinical facilities to identify HIV+ patients whose last HIV laboratory test occurred at the participating facility but who then appeared to be out of care, defined as an absence of HIV laboratory test results reported to MDPH for at least 6months. The clinical facilities then reviewed medical records to determine whether these patients were actually not in care, or if there was another reason that they did not have a laboratory test performed, and provided feedback to MDPH on each of the presumed out-of-care patients. In the first year of the pilot project, 37% of patients who appeared to be out of care based on laboratory data were confirmed to be out of care after review of clinical health records. Of those patients who were confirmed to be out of care, 55% had a subsequent laboratory test within 3months, and 72% had a laboratory test within 6months, indicating that they had re-engaged with a care provider. MDPH found that it was essential to have clinical staff confirm the care status of patients who were presumed to be out of care based on surveillance data.