271150 Trends in health outcomes for HIV patients in rural North Carolina following the implementation of a health information exchange to improve community based practice in HIV

Wednesday, October 31, 2012

Lynne C. Messer, PhD , Duke Global Health Institute, Center for Health Policy and Inequalities Research, Duke University, Durham, NC
Heather Parnell, MSW , Center for Health Policy and Inequalities Research, Duke University, Durham, NC
Samuel Tchwenko, MPH , Center for Health Policy and Inequalities Research, Duke University, Durham, NC
The Carolina HIV Information Cooperative (CHIC) was developed for electronic inter-organizational data sharing to improve the quality of HIV care. CHIC comprises one medical clinic and 5 AIDS Service Organizations serving seven rural counties. The aim was to describe the evolution of 4 outcomes related to the health of, and quality of care received by PLWHA following implementation of the health information exchange.

An Interrupted Time Series design, 1274 consecutive interviews were conducted in 2-week intervals at large university medical clinic. Full segmented regression models resulted in beta coefficients and 95% confidence intervals (95%CI) that estimated pre- and post-interruption trends and level changes for each outcome.

Percentage of clients who adhere to Anti-Retroviral (ARV) drugs showed non-significant pre- and post-interruption trends but rose significantly by 4.5 points (95%CI:3.4,5.6) following interruption. Case management increased by 15 visits per 100 clients (95%CI:14.1,16.6) immediately after the interruption and by 1 visit per 100 clients per month thereafter (95%CI:0.9,1.2) compared to a non-significant baseline trend. Clinic-level CD4 count dropped 36 points (95%CI:-41.4,-30.8) immediately after interruption but showed an upward trend of 2 points (95%CI:1.5,2.5) per month thereafter compared to 1.2 points (95%CI:1.0,1.5) per month pre-intervention. Clinic-level log viral load showed no significant change in level, but demonstrated an upward trend of 0.02 units per month (95%CI:0.01,0.03) post-interruption compared to a negative pre-interruption trend.

This project has led to significant increases in ARV adherence and case management. Although CD4 count level dropped post-interruption, there was a stronger positive trend following interruption than at baseline.

Learning Areas:
Communication and informatics

Learning Objectives:
1. Demonstrate the process of developing an effective health information exchange between medical and ancillary care providers 2. Identify the patient health outcomes shown through quantitative data collection 3. Describe how health information exchange can facilitate improved health outcomes

Keywords: Community Collaboration, Health Information Systems

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am the principal investigator and evaluator on the project being presented.
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.

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