Health Information Exchange: A Novel Re-linkage Intervention in an Urban Health System

Abstract

Background Public health information exchanges (HIEs) link real-time surveillance and clinical data and can help to re-engage out-of-care people with HIV (PWH). Methods We conducted a retrospective cohort study of out-of-care PWH who generated an HIE alert in the Grady Health System (GHS) Emergency Department (ED) between January 2017 and February 2018. Alerts were generated for PWH who registered in the GHS ED without Georgia Department of Public Health (GDPH) CD4 or HIV-1 RNA in the prior 14 months. The alert triggered a social work (SW)–led re-linkage effort. Multivariate logistic regression analyses used HIE-informed SW re-linkage efforts as the independent variable, and linkage to care and 3- and 6-month viral suppression (HIV-1 RNA < 200 c/mL) as primary outcomes. Patients admitted to the hospital were excluded from primary analysis. Results One hundred forty-seven out-of-care patients generated an alert. Ninety-eight were included in the primary analysis (mean age [SD], 41 ± 12 years; 70% male; 93% African American), and 20 received the HIE-informed SW intervention. Sixty percent of patients receiving the intervention linked to care in 6 months, compared with 35% who did not. Patients receiving the intervention were more likely to link to care (adjusted risk ratio [aRR], 1.63; 95% confidence interval [CI], 0.99–2.68) and no more likely to achieve viral suppression (aRR, 1.49; 95% CI, 0.50–4.46) than those who did not receive the intervention. Conclusions An HIE-informed, SW-led intervention systematically identified out-of-care PWH and may increase linkage to care for this important population. HIEs create an opportunity to intervene with linkage and retention strategies.

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

“…In order to consider patients as LTFU (some articles used the term “out-of-care patients” [ 23 – 28 ] to referred patients disengaged from care but are pending to be confirmed as lost) different time periods were reported in the reviewed literature, including at least six [ 23 , 29 ], nine [ 28 , 30 – 38 ], 12 [ 24 – 27 , 39 – 45 ] and even 14 or 15 months since the last appointment to HIV care, CD4 cell count or viral load test [ 46 , 47 ]. Different strategies to find LTFU patients were reported and, in most articles, they were used simultaneously.…”

“…Different strategies to find LTFU patients were reported and, in most articles, they were used simultaneously. Depending on the complexity of LTFU patients, some were reengaged into HIV care was by means of a simple intervention, while others needed other more specialized services, like the referral to drug addiction units or the support of social, mental or prevention services [ 27 – 30 , 38 , 39 , 45 , 46 ]. Although diverse professionals were involved in the tracing and contact procedures, the most common categories were counsellors/patient navigators, while nurses and social workers were less common (Table 2 ).…”

“…Phone calls were used to contact the patient in almost all reviewed articles [ 23 – 38 , 40 – 43 , 46 , 48 – 50 ], with some studies specifying the number of calls made (for instance, a maximum of three calls) and the use of predesigned, tested scripts [ 25 , 30 , 33 , 36 ]. When phone calls were not successful, other contact methods were reported, including mailing notifications (email or postal) to the last known address [ 23 – 26 , 28 , 31 , 34 , 35 , 40 , 41 , 43 , 48 , 49 ], home visits [ 23 – 26 , 28 , 31 – 33 , 48 ], searching for the patient in other public or external databases [ 25 – 28 , 32 , 33 , 41 , 45 , 47 – 49 ] and contacting a close relative or their emergency contact [ 24 , 25 , 30 ].…”

“…In all interventions, professionals offered different procedures in order to reengage LTFU patients, such as identifying possible barriers/reasons for missed appointments and offering alternative solutions to facilitate reengagement and overcome those barriers [ 25 , 26 , 28 , 30 , 32 , 33 , 36 , 39 , 41 , 42 ], rescheduling appointments [ 25 , 26 , 31 – 34 , 42 , 45 ] and giving further information on medication and alternatives to access treatment [ 25 , 27 , 29 , 30 , 38 , 45 , 46 ]. Other important strategy found were building report with the patient and enhancing patient empowerment [ 26 , 29 , 40 , 41 ] by promoting the patient-centred care and setting goals for both patients and clinicians [ 27 , 29 , 31 , 38 ] (Table 3 ).…”

“…During reengagement visits, interventions were focused on encouraging active self-management and self-determination by means of the use of a conversational tone and often assisted by standard printed brochures. Patient-centred and tailored behavioural models like social cognitive theory and wellness motivation theory [ 30 , 38 , 46 – 48 , 50 ], strengths-based case management/counselling and motivational interview and behavioural skills [ 26 – 28 , 33 , 37 , 47 ] were some of the tools used during reengagement visits. According to the literature reviewed, the number of reengagement activities and amount of time invested on them is diverse (Table 3 ).…”