Background Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)—a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. Objective This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. Methods A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant’s life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. Results A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. Conclusions The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness.

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ObjectivesIn 2019, the US Preventative Services Task Force released updated guidelines recommending HIV screening in all individuals aged 15–64 years and all pregnant females. In the current study, we aimed to identify risk factors for HIV infection in an emergency department (ED) population.MethodsWe performed a cross-sectional study that employed a post hoc risk factor analysis of ED patients ≥18 years who were screened for HIV between 27 November 2018 and 26 November 2019, at a single urban, quaternary referral academic hospital. Patients were screened using HIV antigen/antibody testing and diagnoses were confirmed using HIV-1/HIV-2 antibody testing. The outcome of interest was the number of positive HIV tests. Multiple logistic regression models were used to identify risk factors associated with HIV positivity.Results14 335 adult patients were screened for HIV (mean age: 43±14 years; 52% female). HIV seroprevalence was 0.7%. Independent risk factors for HIV positivity included male sex (adjusted OR (aOR) 3.1 (95% CI 1.7 to 5.6)), unhoused status (aOR 2.9 (95% CI 1.7 to 4.9)), history of illicit drug use (aOR 1.8 (95% CI 1.04 to 3.13)) and Medicare insurance status (aOR 2.2 (95% CI 1.1 to 4.4)).ConclusionsThe study ED services a high-risk population with regard to HIV infection. These data support universal screening of ED patients for HIV. Risk factor profiles could improve targeted screening at institutions without universal HIV testing protocols.

168 Background: Individuals with cancer and other serious illness may benefit from specialized models of care, including palliative care. However, limited evidence exists to guide real-world implementation of such programs. We reviewed evidence supporting models of care for serious illness as part of a larger effort to develop an implementation framework for serious illness care programs. Methods: We conducted a systematic review, focusing on existing reviews and meta-analyses across a broad range of serious illness population definitions and programs. The quality of evidence was graded and results were synthesized with respect to five outcomes categories (patient and caregiver experience; care and support processes; health outcomes; health service use and costs; and operations), program components associated with success, and implementation considerations. Results: Collectively, 28 reviews were identified, reporting 743 studies, 426 of which were randomized controlled trials. The strongest and most consistent evidence was for reduced health service use and costs (e.g., reduced hospitalization and emergency department use) and for improved patient and caregiver experiences. Few reviews reported on operational outcomes. Program components most frequently reported as associated with success included targeted selection of high-risk patients; face-to-face contact; and transition management. Common recommendations for implementation (reported in 10 of 28 reviews) included attention to relationship building, inclusion of technology-enabled decision support and continuous quality improvement. Conclusions: Compelling evidence exists for improved outcomes across a range of serious illness care models and populations with palliative care needs. Policy attention to payment structures that support feasibility and sustainability of these care models is warranted. Future research might address gaps in the literature, including implementation-related factors, operational outcomes and the relative contribution of individual components associated with program success.