177179 Structures and Processes of Care in the Clinics of the HIV Research Network (HIVRN)

Wednesday, October 29, 2008

Baligh R. Yehia, MD , Johns Hopkins School of Medicine, Baltimore, MD
Kelly A. Gebo, MD, MPH , Johns Hopkins School of Medicine, Baltimore, MD
Perrin Hicks, MPH , Johns Hopkins School of Medicine, Baltimore, MD
P. Todd Korthuis, MD , Oregon Health and Sciences University, Portland, OR
John A. Fleishman, PhD , Agency for Healthcare Research and Quality, Rockville, MD
Michelande Ridoré, BA , Johns Hopkins School of Medicine, Baltimore, MD
Wm. Christopher Mathews, MD, MSPH , University of California San Diego, San Diego, CO
Background: The optimal processes and structures of HIV outpatient care are unknown. Using the HIV Research Network (HIVRN), this study attempted to: (1) describe the organization and processes of care in HIVRN adult clinics; and (2) estimate variability among clinics in these parameters. Methods: Cross sectional survey of clinic directors regarding: (1) patient volume; (2) no-show rates; (3) annual accrual and loss to follow up; (4) provider characteristics; (5) patient panel size; (6) use of urgent visits; (7) off-hours care; (8) availability of consult services; (9) patient safety processes; and (10) prophylaxis practices. Results: All 15 adult HIVRN clinic sites responded – 9 academic and 6 community based. The median [range] of selected practice characteristics were: (1) annual patient panel size 1,300 [355 – 5,600]; (2) appointment no-show rate 28% [8 – 40%]; and (3) annual loss to follow up 17% [5 – 25%]. Midlevel practitioners are utilized in 86% of clinics. Structures to address acute issues in HIVRN clinics include on-call systems (87%), same day appointments (87%), and explicit walk-in policies (80%). On-site consultative services include: case management (93%), clinical pharmacy (87%), psychiatry (67%), and substance abuse treatment (67%). Patient safety protocols include screening for adverse drug interactions (47%) and management of critical laboratory results (93%). Conclusions: Key practice parameters vary widely at high volume HIV clinics. Midlevel providers are highly utilized. The majority of clinics have an internal mechanism to handle acute patient care issues. This data will facilitate benchmarking of best practices to improve the efficiency and outcomes of care.

Learning Objectives:
1. Describe how acute health care issues are addressed by high volume, adult HIV clinics 2. Identify patient safety processes implemented by adult HIV Research Network clinics 3. Recognize how HIV Research Network clinic structures and processes of care can facilitate outpatient HIV clinic design and quality improvement programs

Keywords: HIV/AIDS, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was directly involved in the collection, processing, and analysis of all data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.