Comparative Cost Analysis of Clinical Reminder for HIV Testing at the Veterans Affairs Healthcare System

Abstract

The clinical reminder system can reduce the cost per cases identified and promote better performance of HIV testing compared with traditional HIV testing. The fundamental decision model can be used for hospital facilities outside the Veteran Affairs adopting a similar program for improving the HIV testing rate.

Clinical decision support systems to guide healthcare providers on HIV testing

“…The geographical distribution of the included studies was limited in scope and from HIV low endemic settings predominantly (Fig. 2); the majority of the studies were conducted in the United States of America (n ¼ 17) [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], with the remaining studies from the United Kingdom (n ¼ 2) [37,38], Kenya (n ¼ 1) [39], and Argentina (n ¼ 1) [40], with one not stating a country [41]. Most studies were implementation studies (n ¼ 20) comparing HIV testing preimplementation and postimplementation of CDSSs, with only two randomized control trials [34,39].…”

“…Most studies were implementation studies (n ¼ 20) comparing HIV testing preimplementation and postimplementation of CDSSs, with only two randomized control trials [34,39]. Study settings were hospitals (n ¼ 12) [21,22,26,[29][30][31]33,36,[38][39][40][41], nonhospital (n ¼ 9) [20,[23][24][25]27,28,32,34,35] or combined (n ¼ 1) [37]. The setting was defined based on the clinical medical setting and the electronic data tools that tend to be available to these settings.…”

“…'Combined' setting referred to studies looking at CDSSs within both hospital and nonhospital-based settings. Studies mainly targeted general adult populations aged 13 and over (n ¼ 16) [20][21][22]24,26,[29][30][31][32][33][35][36][37][38]40,41], five focused on veterans [23,25,27,28,34] and one study from Kenya focused solely on a paediatric population [39].…”

“…Amongst the 22 included studies reporting on CDSSs, two types of alert systems were identified. The majority were electronic clinical reminders (n ¼ 18) [20,[22][23][24][25][26][27][28][30][31][32][33][34][35][36][39][40][41], with the remaining studies reporting on electronic laboratory reminders (n ¼ 3) [21,37,38] or a combination of both (n ¼ 1) [29]. CDSSs that acted as electronic clinical reminders mainly focused on universal screening (alerting healthcare providers to perform a routine HIV test for all patients without known HIV infection and without a documented recent HIV test).…”

Zugangsschwellen zu HIV-Test-Angeboten – Eine systematische Literaturanalyse

“…B. Arya und Chan, die Klienten aus diesen Personengruppen in regelmäßigen Abständen an den HIV-Test zu erinnern. V. a. Kurznachrichten scheinen als Medium hierfür erprobt zu sein [116][117][118].…”