A System-Level Approach to Improve HIV Screening in an Urban Pediatric Primary Care Setting

Arrington‐Sanders, Renata; Wheeler, Noah J.; Matson, Pamela A.; Kim, Julia M.; Tawe, Marie Sophie; Tomaszewski, Kathy; Campbell, Nancy; Rogers, Jamie; Upadhya, Krishna K.; Marcell, Arik V.

doi:10.1542/peds.2018-0506

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…Similarly, programs in urban primary care networks used dedicated health educators to alleviate physicians' time constraints. 8,26 Concerns about confidentiality are known to be a key barrier to adolescents seeking sexual and reproductive care applicable to HIV screening. A review 10 that synthesized studies about confidentialityrelated factors identified themes relevant to adolescents.…”

Section: Discussionmentioning

confidence: 99%

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Shakir,

Doshi,

Blakeslee

et al. 2023

Pediatr Emer Care

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Objectives Our objective was to increase human immunodeficiency virus (HIV) screening in adolescents presenting to our community pediatric emergency department with symptoms suggestive of a sexually transmitted infection (STI) and who were being tested for gonorrhea and chlamydia. Specifically, we aimed to increase the monthly average proportion of adolescents concurrently screened for HIV in this target group from 11% to 50% in 6 months. Methods We identified barriers to HIV screening, focusing on physician-related challenges and adolescents' concerns about confidentiality. We designed interventions targeting these barriers and implemented them in plan-do-study-act cycles beginning in February 2020. We educated physicians and nurses about screening recommendations, emphasized a physician-conducted private interview during which confidential contact information could be obtained, and assured confidentiality on after visit summaries by removing STI results. We also provided regular feedback to physicians on the screening rate. In addition, we implemented an electronic health record quick order set and a documentation tool. Using a statistical process control chart, we measured the average monthly proportion of adolescents in the target group who were offered HIV screening or tested for HIV before and after interventions. Results A total of 140 adolescents in the target group presented to our pediatric emergency department from February 2020 through December 2021. After plan-do-study-act cycles, the average monthly screening rate increased to 80%. Conclusions Raising physician awareness of HIV screening recommendations and the importance of conducting a private interview improved screening rates. Assuring adolescent minors of confidentiality in a private interview, removing STI results from the after visit summary, and obtaining confidential contact information were important measures to overcome confidentiality barriers.

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Section: Discussionmentioning

confidence: 99%

“…A recent review 18 summarizing HIV screening programs in US PEDs 19–25 showed that all were conducted at large academic centers or children's hospitals, and several had dedicated staff resources and funding. Similarly, programs in urban primary care networks used dedicated health educators to alleviate physicians' time constraints 8,26 …”

Section: Discussionmentioning

confidence: 99%

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Shakir,

Doshi,

Blakeslee

et al. 2023

Pediatr Emer Care

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“…Quality improvement projects performed in various primary care and specialist settings have increased HIV screening rates but the effects have been either small and not population based. [17][18][19] Using concepts of audit and feedback to improve practice outcomes, we identified a need for quality improvement and an attainable goal to increase HIV screening rates within our KP healthcare system. 20 21 Using successive rounds of real-time audit and feedback in the form of a HIV screening report card, cohort PCPs were given a summary of their clinical performance and were compared with their peers.…”

Section: Discussionmentioning

confidence: 99%

Using a report card to increase HIV screening in a large primary care group practice

et al. 2021

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BackgroundDespite increased efforts to promote HIV screening, a large proportion of the US population have never been tested for HIV.ObjectiveTo determine whether provider education and personalised HIV screening report cards can increase HIV screening rates within a large integrated healthcare system.DesignThis quality improvement study provided a cohort of primary care physicians (PCPs) a brief educational intervention and personalised HIV screening report cards with quarterly performance data.ParticipantsParticipants included a volunteer cohort of 20 PCPs in the department of adult and family medicine.Main measuresPer cent of empaneled patients screened for HIV by cohort PCPs compared with PCPs at the Kaiser Permanente Oakland Medical Center (KPOAK) and the non-Oakland Medical Centers in Northern California region (Kaiser Permanente Northern California (KPNC)).Key resultsOf the 20 participating PCPs, 13 were female and 7 were male. Thirteen were internal medicine and seven family medicine physicians. The average age was 40 years and average practice experience was 9 years after residency. During the 12-month intervention, the estimated increase in HIV screening in the cohort PCP group was 2.6% as compared with 1.9% for KPOAK and 1.8% for KPNC.ConclusionsThese findings suggest that performance-related report cards are associated with modestly increased rates of HIV screening by PCPs.

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“…Plan-do-study-act (PDSA) cycles are an innovative method for evaluating and refining interventions to improve workflow and clinical outcomes. 7 PDSA provides a structured framework for testing changes on a small scale and rapidly applying what is learnt to inform interventions before large-scale implementation. 8 Recent findings demonstrate how adaptations to quality improvement efforts are necessary when facing crisis situations like the COVID-19 pandemic to allow a quick response while optimising patient safety.…”

Section: Objectivesmentioning

confidence: 99%

“…Plan–do–study–act (PDSA) cycles are an innovative method for evaluating and refining interventions to improve workflow and clinical outcomes 7. PDSA provides a structured framework for testing changes on a small scale and rapidly applying what is learnt to inform interventions before large-scale implementation 8.…”

Section: Objectivesmentioning

confidence: 99%

Changes in the time of COVID-19: a quality improvement initiative to maintain services at a youth sexual health clinic

et al. 2021

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ObjectivesAdolescents and young adults (AYAs) face difficulties accessing sexual and reproductive health services. These difficulties were exacerbated for a variety of reasons by the COVID-19 pandemic. We document strategies and outcomes implemented at an urban youth sexual health clinic in Florida that allowed uninterrupted provision of services while protecting against spread of COVID-19.MethodsThe plan–do–study–act (PDSA) model was used to implement COVID-19 interventions designed to allow continued service delivery while protecting the health and safety of staff and patients. This method was applied to clinic operations, community referral systems and community outreach to assess and refine interventions within a quick-paced feedback loop.ResultsDuring the COVID-19 pandemic, changes made via PDSA cycles to clinical/navigation services, health communications and youth outreach/engagement effectively responded to AYA needs. Although overall numbers of youth served decreased, all youth contacting the clinic for services were able to be accommodated. Case finding rates for chlamydia, gonorrhoea, syphilis and HIV were similar to pre-pandemic levels.ConclusionsQuality improvement PDSA initiatives at AYA sexual health clinics, particularly those for underserved youth, can be used to adapt service delivery when normal operating models are disrupted. The ability for youth sexual health clinics to adapt to a changing healthcare landscape will be crucial in ensuring that under-resourced youth are able to receive needed services and ambitious Ending the HIV Epidemic goals are achieved.

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A System-Level Approach to Improve HIV Screening in an Urban Pediatric Primary Care Setting

Cited by 9 publications

References 36 publications

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Using a report card to increase HIV screening in a large primary care group practice

Changes in the time of COVID-19: a quality improvement initiative to maintain services at a youth sexual health clinic

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