The document summarizes the integration of routine HIV testing within the New York City Health and Hospitals Corporation (HHC) public hospital system. It finds that between 2005-2007, the percentage of unique patients tested for HIV increased across HHC facilities while overall patient volume remained stable. The number of patients newly diagnosed with HIV also increased in 2007. While testing expanded in various settings, most efforts focused on outpatient and emergency departments. The data provides lessons for increasing HIV testing rates and linking patients to ongoing care.
This document summarizes the results of a program implemented across the MedStar Health network to improve hepatitis C virus (HCV) testing and linkage to care. Key results include:
- Of over 50,000 patients in the birth cohort (born 1945-1965) tested for HCV antibodies, 1% (64 patients) tested positive.
- Testing was higher in women overall, but men were more likely to test HCV antibody positive.
- The next steps of the program are to improve linkage to care for those testing positive and identify barriers to testing and care.
This document summarizes the results of a program implemented across the MedStar Health network to improve hepatitis C virus (HCV) testing and linkage to care. Key results include:
- Of over 50,000 patients in the birth cohort (born 1945-1965) tested for HCV antibodies, 1% (64 patients) tested positive.
- Testing was higher in women overall, but men were more likely to test HCV antibody positive.
- The next steps of the program are to improve linkage to care for those testing positive and identify barriers to broader HCV testing.
Introduction & Functions of Quality Department Dr Sajid Omer
Dr. Sajid Omer is the Chief of Quality at an organization. Quality is the result of intention, effort, direction, and execution. The organization has various teams and committees focused on quality assurance, including a quality assurance team, infection control team, and clinical pharmacologist. The quality assurance department conducts internal audits, process evaluations, analyzes data and feedback, and monitors for accreditation. Quality is defined by various metrics in different departments like diagnostics, medication management, surgery, infection rates, and patient satisfaction. The document outlines the organization's focus on continuous quality improvement.
The study found that patient confidence in visiting healthcare providers is increasing in May. The percentage of patients delaying appointments is at its lowest level. Most patients expect to resume regular in-office visits within the next 1-2 months. Comfort levels in visiting primary care physicians and specialists have also increased. The use of telemedicine has grown significantly during the pandemic with 30% of patients using it in the past 3 months. Over half of patients feel that some appointments can be replaced by telehealth.
In this downloadable slideset, Joel E. Gallant, MD, MPH, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at upcoming agents currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 3.00 MB
Date posted: 6/15/2015
This document summarizes research investigating the effect of provider incentives for influenza immunization through longitudinal studies using two datasets. It finds that reported achievement generally increased over time with the Quality and Outcomes Framework (QOF), but this was partly due to increased exception reporting. Increasing the upper threshold for one indicator led to greater improvements in reported achievement compared to other indicators. Analyzing data prior to QOF allows disentangling the effects of different incentive schemes over time on immunization rates in various patient groups.
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...hivlifeinfo
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
Clinical Impact of Data From the CROI 2015,SeattleHivlife Info
This document summarizes key findings from the 2015 Conference on Retroviruses and Opportunistic Infections regarding HIV prevention and antiretroviral therapy. Studies presented showed that immediate use of PrEP reduced HIV risk by 86% compared to deferred use in high-risk MSM. On-demand PrEP also reduced risk by 86% in another study of MSM. Combining ART and PrEP in serodiscordant couples reduced expected infections by 96%. Regarding ART, tenofovir alafenamide fumarate was found to be noninferior to tenofovir disoproxil fumarate at week 48, with less impact on renal and bone safety markers.
This document summarizes the results of a program implemented across the MedStar Health network to improve hepatitis C virus (HCV) testing and linkage to care. Key results include:
- Of over 50,000 patients in the birth cohort (born 1945-1965) tested for HCV antibodies, 1% (64 patients) tested positive.
- Testing was higher in women overall, but men were more likely to test HCV antibody positive.
- The next steps of the program are to improve linkage to care for those testing positive and identify barriers to testing and care.
This document summarizes the results of a program implemented across the MedStar Health network to improve hepatitis C virus (HCV) testing and linkage to care. Key results include:
- Of over 50,000 patients in the birth cohort (born 1945-1965) tested for HCV antibodies, 1% (64 patients) tested positive.
- Testing was higher in women overall, but men were more likely to test HCV antibody positive.
- The next steps of the program are to improve linkage to care for those testing positive and identify barriers to broader HCV testing.
Introduction & Functions of Quality Department Dr Sajid Omer
Dr. Sajid Omer is the Chief of Quality at an organization. Quality is the result of intention, effort, direction, and execution. The organization has various teams and committees focused on quality assurance, including a quality assurance team, infection control team, and clinical pharmacologist. The quality assurance department conducts internal audits, process evaluations, analyzes data and feedback, and monitors for accreditation. Quality is defined by various metrics in different departments like diagnostics, medication management, surgery, infection rates, and patient satisfaction. The document outlines the organization's focus on continuous quality improvement.
The study found that patient confidence in visiting healthcare providers is increasing in May. The percentage of patients delaying appointments is at its lowest level. Most patients expect to resume regular in-office visits within the next 1-2 months. Comfort levels in visiting primary care physicians and specialists have also increased. The use of telemedicine has grown significantly during the pandemic with 30% of patients using it in the past 3 months. Over half of patients feel that some appointments can be replaced by telehealth.
In this downloadable slideset, Joel E. Gallant, MD, MPH, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at upcoming agents currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 3.00 MB
Date posted: 6/15/2015
This document summarizes research investigating the effect of provider incentives for influenza immunization through longitudinal studies using two datasets. It finds that reported achievement generally increased over time with the Quality and Outcomes Framework (QOF), but this was partly due to increased exception reporting. Increasing the upper threshold for one indicator led to greater improvements in reported achievement compared to other indicators. Analyzing data prior to QOF allows disentangling the effects of different incentive schemes over time on immunization rates in various patient groups.
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...hivlifeinfo
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
Clinical Impact of Data From the CROI 2015,SeattleHivlife Info
This document summarizes key findings from the 2015 Conference on Retroviruses and Opportunistic Infections regarding HIV prevention and antiretroviral therapy. Studies presented showed that immediate use of PrEP reduced HIV risk by 86% compared to deferred use in high-risk MSM. On-demand PrEP also reduced risk by 86% in another study of MSM. Combining ART and PrEP in serodiscordant couples reduced expected infections by 96%. Regarding ART, tenofovir alafenamide fumarate was found to be noninferior to tenofovir disoproxil fumarate at week 48, with less impact on renal and bone safety markers.
IAS 2015.8th IAS Conference on HIV Pathogenesis, Treatment and Preventionhivlifeinfo
Highlights of IAS 2015
In this downloadable slideset, Andrew Carr, MBBS, MD, FRACP, FRCPA; Joel E. Gallant, MD, MPH; and Anton L. Pozniak, MD, FRCP, review key studies presented at the 2015 International AIDS Society conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.73 MB
The document discusses opportunities and challenges for drug developers in the orphan disease space. It notes that while regulatory incentives and unmet medical need make orphan diseases attractive, drug developers must prepare for unique challenges such as lack of disease understanding, difficult patient identification and recruitment for clinical trials, and increasing restrictions from payers on pricing and access. Overall the orphan disease market remains an important area of focus for companies, but success will require strategies tailored to the complexities of these rare conditions.
This document summarizes a presentation on urine drug testing and monitoring prescription drug use. It discusses how prescription drug monitoring programs identify, investigate, and address fraud, waste and abuse related to prescription drug use and urine drug testing. It outlines trends seen in urine drug testing results that indicate issues with adherence, illicit drug use, and inconsistencies between prescribed medications and test results. Best practices are discussed for utilizing utilization review, case management, and other tools to help ensure appropriate use of medications and compliance with treatment regimens. The impacts of compounds, opioids, and long term opioid use are also addressed.
This talk introduces the concept of a new generation of pulmonary embolism (PE). What was once considered a deadly disease process now carries a mortality rate of <3%, which may be driven by overtesting as well as overdiagnosis. This talk will explore this phenomenon and current evidence-based approaches to the evaluation and treatment of PEs.
Ομιλία - Παρουσίαση: “Βιοδείκτες: Η Κλινική τους Αξία και η Σχέση τους με τον ΕΟΠΥΥ”
Νικόλαος Τσούλος, MSc, MBA, Βιοχημικός, Διευθύνων Σύμβουλος GeneKor Medical SA
Should Integrase Inhibitors Be Your First Choice When Starting HIV Therapy- E...Hivlife Info
In this downloadable slideset, Joseph J. Eron, Jr., MD, and Daniel Kuritzkes, MD, review key data on the evolving use of INSTIs in patients beginning HIV therapy.
Format: Microsoft PowerPoint (.ppt)
File size: 2.29 MB
The document discusses using HIV program data to evaluate gaps and disparities in linkage to care. It provides examples of how Louisiana measures linkage, retention, and viral suppression, and presents continuum of care data for the state overall and by region, race/ethnicity, and testing site. Linkage to care rates for newly diagnosed individuals are shown to be improving over time but still vary between regions and community-based organizations. The document encourages evaluating one's own agency's linkage data and identifying opportunities for the State HIV Program to provide more useful data support.
Presentation from OIS@ASCRS 2016
Moderator:
Elizabeth Yeu, MD
Participants:
David Chang, MD
Eric Donnenfeld, MD
Sherman Reeves, MD, MPH
Denise Visco, MD
Video Presentation:
https://www.youtube.com/watch?v=GTiBOslQYlI&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw&index=37
In this downloadable slideset, Joseph J. Eron, Jr., MD, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at potential future agents and strategies currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Date posted: 6/1/2016
IPOS10 T680 - Implementation of a Screening Programme for Cancer Related Dist...Alex J Mitchell
This document describes a study examining the implementation of a screening program for cancer-related distress. It found that screening increased clinicians' detection of distress, led to more patients' needs being met, and improved quality of care. Specifically, clinicians were more likely to offer help to patients who screened positive for distress or depression. The screening also clarified unmet needs and patients' desire for help. Based on these results, the study will move forward with an RCT of screening plus intervention for patients receiving radiotherapy.
Disparities in Patient Safety - Presentation from 2013 Maryland Patient Safet...Noel Eldridge
The document summarizes preliminary findings from the Medicare Patient Safety Monitoring System (MPSMS) regarding potential patient safety disparities. MPSMS measures 21 patient safety indicators, including adverse drug events, hospital-acquired infections, and complications from procedures. Preliminary analysis of 2010-2011 MPSMS data shows some disparities, with Black patients sometimes having higher exposure and adverse event rates than White patients for certain measures like hospital-acquired infections and adverse drug events. The small sample sizes for racial/ethnic subgroups limit the ability to detect all potential disparities. Combining multiple years of MPSMS data could provide more insights into disparities while addressing limitations of small sample sizes.
The survey assessed the knowledge of 46 attendees of a community event on sexual health issues. The key findings were: 1) 64% correctly identified Syracuse as having the highest rate of syphilis infections. 2) 83% correctly said all populations are at risk for HIV/AIDS. 3) 61% would get tested at a doctor's office. 4) 98% knew the main service provided is HIV/AIDS education. 5) 56% understood PrEP prevents HIV. However, the small sample limits generalizing the results.
BioSHaRE: Risk stratification using genomic and lifestyle information - Samul...Lisette Giepmans
This document discusses using genomic and lifestyle data for cardiovascular disease risk stratification. It summarizes that genome-wide studies have provided unprecedented information about genetic backgrounds of complex diseases. Large-scale prospective data combining genomic screening, lifestyle factors, and long-term health outcomes could be used to develop personalized risk algorithms and apps to communicate risk. Pilot studies in Finland have shown genetic risk scores can reclassify risk and identify additional individuals who could benefit from prevention.
Модификация схем АРТ у пациентов с вирусной супрессией и после вирусологичес...hivlifeinfo
This document discusses best practices for switching antiretroviral therapy (ART) regimens in virologically suppressed patients and after virologic failure. It provides an overview of reasons to consider switching ART in suppressed patients, such as improving tolerability or managing drug interactions. Principles of switching include reviewing resistance history and increasing viral load monitoring post-switch. Studies show switching from efavirenz-containing regimens can improve neurological side effects. Switching to newer regimens like dolutegravir or elvitegravir/cobicistat was found to maintain viral suppression in most patients.
Improved Performance of the Malaria Surveillance, Monitoring, and Evaluation ...MEASURE Evaluation
MEASURE Evaluation's support between 2015-2018 likely contributed to significant improvements in Madagascar's malaria surveillance system. Key improvements included: 1) availability of guiding documents, 2) increased completeness and timeliness of facility and community reporting, and 3) establishment of a culture of data dissemination and use. Data quality, reporting rates, and staff capacity all significantly increased over this period according to the assessment. Continued support is needed as Madagascar works towards malaria elimination.
Objective
Safer Healthcare Now!, a program of the Canadian Patient Safety Institute, invites you to participate in the Canadian VTE Audit, designed to establish a national perspective of VTE thromboprophylaxis rates and raise awareness of appropriate VTE prophylaxis.
VTE is one of the most common and preventable complications of hospitalization and is a Required Organizational Practice (ROP) of Accreditation Canada.
By participating in the national audit day you will be a part of a movement aimed at preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospital patients.
Watch the recording: http://bit.ly/1wfinCE
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
Dr. Jason Ross - Improving Sow SurvivabilityJohn Blue
Improving Sow Survivability - Dr. Jason Ross, Iowa State University, From the 2018 World Pork Expo, June 6 - 8, 2018, Des Moines, IA, USA.
More presentations at http://www.swinecast.com/2018-world-pork-expo
This study conducted a telephone survey of labor and delivery units at U.S. hospitals to determine the prevalence of hospital policies addressing non-medically indicated deliveries prior to 39 weeks gestation. They found that 66.5% of responding hospitals reported having such a policy. Hospitals in states with initiatives to reduce early deliveries were more likely to have a policy, with 67.8% of hospitals in initiative states reporting a policy compared to 62.1% in non-initiative states. The majority (68.8%) of policies were coded as having a "hard stop" against early deliveries. The study concludes that state initiatives can effectively encourage more hospitals to adopt restrictive policies on non-medically indicated early deliver
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
IAS 2015.8th IAS Conference on HIV Pathogenesis, Treatment and Preventionhivlifeinfo
Highlights of IAS 2015
In this downloadable slideset, Andrew Carr, MBBS, MD, FRACP, FRCPA; Joel E. Gallant, MD, MPH; and Anton L. Pozniak, MD, FRCP, review key studies presented at the 2015 International AIDS Society conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.73 MB
The document discusses opportunities and challenges for drug developers in the orphan disease space. It notes that while regulatory incentives and unmet medical need make orphan diseases attractive, drug developers must prepare for unique challenges such as lack of disease understanding, difficult patient identification and recruitment for clinical trials, and increasing restrictions from payers on pricing and access. Overall the orphan disease market remains an important area of focus for companies, but success will require strategies tailored to the complexities of these rare conditions.
This document summarizes a presentation on urine drug testing and monitoring prescription drug use. It discusses how prescription drug monitoring programs identify, investigate, and address fraud, waste and abuse related to prescription drug use and urine drug testing. It outlines trends seen in urine drug testing results that indicate issues with adherence, illicit drug use, and inconsistencies between prescribed medications and test results. Best practices are discussed for utilizing utilization review, case management, and other tools to help ensure appropriate use of medications and compliance with treatment regimens. The impacts of compounds, opioids, and long term opioid use are also addressed.
This talk introduces the concept of a new generation of pulmonary embolism (PE). What was once considered a deadly disease process now carries a mortality rate of <3%, which may be driven by overtesting as well as overdiagnosis. This talk will explore this phenomenon and current evidence-based approaches to the evaluation and treatment of PEs.
Ομιλία - Παρουσίαση: “Βιοδείκτες: Η Κλινική τους Αξία και η Σχέση τους με τον ΕΟΠΥΥ”
Νικόλαος Τσούλος, MSc, MBA, Βιοχημικός, Διευθύνων Σύμβουλος GeneKor Medical SA
Should Integrase Inhibitors Be Your First Choice When Starting HIV Therapy- E...Hivlife Info
In this downloadable slideset, Joseph J. Eron, Jr., MD, and Daniel Kuritzkes, MD, review key data on the evolving use of INSTIs in patients beginning HIV therapy.
Format: Microsoft PowerPoint (.ppt)
File size: 2.29 MB
The document discusses using HIV program data to evaluate gaps and disparities in linkage to care. It provides examples of how Louisiana measures linkage, retention, and viral suppression, and presents continuum of care data for the state overall and by region, race/ethnicity, and testing site. Linkage to care rates for newly diagnosed individuals are shown to be improving over time but still vary between regions and community-based organizations. The document encourages evaluating one's own agency's linkage data and identifying opportunities for the State HIV Program to provide more useful data support.
Presentation from OIS@ASCRS 2016
Moderator:
Elizabeth Yeu, MD
Participants:
David Chang, MD
Eric Donnenfeld, MD
Sherman Reeves, MD, MPH
Denise Visco, MD
Video Presentation:
https://www.youtube.com/watch?v=GTiBOslQYlI&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw&index=37
In this downloadable slideset, Joseph J. Eron, Jr., MD, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at potential future agents and strategies currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Date posted: 6/1/2016
IPOS10 T680 - Implementation of a Screening Programme for Cancer Related Dist...Alex J Mitchell
This document describes a study examining the implementation of a screening program for cancer-related distress. It found that screening increased clinicians' detection of distress, led to more patients' needs being met, and improved quality of care. Specifically, clinicians were more likely to offer help to patients who screened positive for distress or depression. The screening also clarified unmet needs and patients' desire for help. Based on these results, the study will move forward with an RCT of screening plus intervention for patients receiving radiotherapy.
Disparities in Patient Safety - Presentation from 2013 Maryland Patient Safet...Noel Eldridge
The document summarizes preliminary findings from the Medicare Patient Safety Monitoring System (MPSMS) regarding potential patient safety disparities. MPSMS measures 21 patient safety indicators, including adverse drug events, hospital-acquired infections, and complications from procedures. Preliminary analysis of 2010-2011 MPSMS data shows some disparities, with Black patients sometimes having higher exposure and adverse event rates than White patients for certain measures like hospital-acquired infections and adverse drug events. The small sample sizes for racial/ethnic subgroups limit the ability to detect all potential disparities. Combining multiple years of MPSMS data could provide more insights into disparities while addressing limitations of small sample sizes.
The survey assessed the knowledge of 46 attendees of a community event on sexual health issues. The key findings were: 1) 64% correctly identified Syracuse as having the highest rate of syphilis infections. 2) 83% correctly said all populations are at risk for HIV/AIDS. 3) 61% would get tested at a doctor's office. 4) 98% knew the main service provided is HIV/AIDS education. 5) 56% understood PrEP prevents HIV. However, the small sample limits generalizing the results.
BioSHaRE: Risk stratification using genomic and lifestyle information - Samul...Lisette Giepmans
This document discusses using genomic and lifestyle data for cardiovascular disease risk stratification. It summarizes that genome-wide studies have provided unprecedented information about genetic backgrounds of complex diseases. Large-scale prospective data combining genomic screening, lifestyle factors, and long-term health outcomes could be used to develop personalized risk algorithms and apps to communicate risk. Pilot studies in Finland have shown genetic risk scores can reclassify risk and identify additional individuals who could benefit from prevention.
Модификация схем АРТ у пациентов с вирусной супрессией и после вирусологичес...hivlifeinfo
This document discusses best practices for switching antiretroviral therapy (ART) regimens in virologically suppressed patients and after virologic failure. It provides an overview of reasons to consider switching ART in suppressed patients, such as improving tolerability or managing drug interactions. Principles of switching include reviewing resistance history and increasing viral load monitoring post-switch. Studies show switching from efavirenz-containing regimens can improve neurological side effects. Switching to newer regimens like dolutegravir or elvitegravir/cobicistat was found to maintain viral suppression in most patients.
Improved Performance of the Malaria Surveillance, Monitoring, and Evaluation ...MEASURE Evaluation
MEASURE Evaluation's support between 2015-2018 likely contributed to significant improvements in Madagascar's malaria surveillance system. Key improvements included: 1) availability of guiding documents, 2) increased completeness and timeliness of facility and community reporting, and 3) establishment of a culture of data dissemination and use. Data quality, reporting rates, and staff capacity all significantly increased over this period according to the assessment. Continued support is needed as Madagascar works towards malaria elimination.
Objective
Safer Healthcare Now!, a program of the Canadian Patient Safety Institute, invites you to participate in the Canadian VTE Audit, designed to establish a national perspective of VTE thromboprophylaxis rates and raise awareness of appropriate VTE prophylaxis.
VTE is one of the most common and preventable complications of hospitalization and is a Required Organizational Practice (ROP) of Accreditation Canada.
By participating in the national audit day you will be a part of a movement aimed at preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospital patients.
Watch the recording: http://bit.ly/1wfinCE
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
Dr. Jason Ross - Improving Sow SurvivabilityJohn Blue
Improving Sow Survivability - Dr. Jason Ross, Iowa State University, From the 2018 World Pork Expo, June 6 - 8, 2018, Des Moines, IA, USA.
More presentations at http://www.swinecast.com/2018-world-pork-expo
This study conducted a telephone survey of labor and delivery units at U.S. hospitals to determine the prevalence of hospital policies addressing non-medically indicated deliveries prior to 39 weeks gestation. They found that 66.5% of responding hospitals reported having such a policy. Hospitals in states with initiatives to reduce early deliveries were more likely to have a policy, with 67.8% of hospitals in initiative states reporting a policy compared to 62.1% in non-initiative states. The majority (68.8%) of policies were coded as having a "hard stop" against early deliveries. The study concludes that state initiatives can effectively encourage more hospitals to adopt restrictive policies on non-medically indicated early deliver
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
Leah Binder Presentation on Leapfrog Group on Maternity CareTherese Gratia
1) The document discusses innovations in maternity care, focusing on data from The Leapfrog Group on key measures of maternity quality such as early elective deliveries, C-section rates, and episiotomies.
2) Early elective deliveries have declined significantly from 17% to 1.9% due to efforts to reduce them, though C-section rates still vary between states and purchasers can help further improve quality through payment reform and benefits design.
3) Maternity care quality appears unaffected by hospital type and The Leapfrog Group is a nonprofit that publicly reports on hospital performance and safety to empower purchasers and consumers.
1) The document discusses innovations in maternity care, focusing on data from The Leapfrog Group on key measures of maternity quality such as early elective deliveries, C-section rates, and episiotomies.
2) Early elective deliveries have declined significantly from 17% to just 1.9% due to efforts to reduce them. However, C-section rates still vary between states and have not decreased from 2015.
3) Episiotomy rates have fallen but are still too high at 9.6%. The Leapfrog Group also examines adherence to processes of maternity care.
Ochsner Health System created its Center for Innovation in 2013 to develop new care delivery models using emerging technologies. It partnered with Apple to integrate patient data from Apple HealthKit into its Epic electronic health record, allowing seamless sharing of health information between patients and physicians. This integration allows for real-time monitoring of chronic conditions like heart failure. Ochsner is focused on chronic disease management and using new technologies to target behavioral factors influencing health outcomes. It prioritizes reducing heart failure readmissions through targeted chronic care management with nurse monitoring and at-home weight tracking.
Mobile Health at Ochsner: The Apple HealthKit and Epic EMR IntegrationRahlyn Gossen
The document discusses innovation in health care delivery at Ochsner Health System. It describes how Ochsner Center for Innovation was created in 2013 to develop new care delivery models using the newest technologies. It provides examples of innovations like integrating Ochsner's electronic health record with Apple HealthKit to allow seamless sharing of patient data between patients and physicians. The document advocates for an innovative model of care delivery that utilizes technology to remotely monitor and manage large patient populations with chronic conditions in a more efficient way.
Presentation on the results to date of the Federal Partnership for Patients (...Noel Eldridge
The document discusses national estimates of hospital-acquired conditions (HACs) in the United States before and after the launch of the Partnership for Patients initiative. It provides an overview of the initiative's goals to reduce HACs by 40% and readmissions by 20% by 2014. Interim analysis of data from 2010-2013 shows a 17% reduction in the HAC rate, avoiding an estimated 35,000 deaths and saving $8 billion in 2013. The analysis indicates progress toward the initiative's goals but notes limitations in the measurement methods.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Survillance and notification of communicable diseasemubeenButt5
Ongoing, systematic collection, analysis and interpretation of health data.
Surveillance and notification of communicable disease
1-Closely integrated with the timely dissemination to those who need to know.
Application of the data to preventing and controlling disease.
2-Authoritative or urgent, formal or legal notice.
The action of notifying someone or something.
Something that gives official information to someone : the act of notifying someone.
3-Monitor closely to all patients.
Collect patient’s data for clinical decision making.
Monitor different diagnostic tests and lab investigations if needed.
Implement interventions on patients and evaluate for the outcomes.
To conduct researches nurse can collect data.
To assess status of community and identify problems.
To detect changes in health care practices .
Administration of general and specific health survey.
Participation in early diagnosis and treatment
Identification and notification of certain specific diseases.
Health education.
5-Crude birth rate
Crude death rate
Infant mortality rate
Morbidity rate
Perinatal mortality rate
Maternal mortality rate
Life expectancy
General fertility rate
This is part 2 of the Central Illinois HIE Summit: Patient Care & Connectivity, held Sept. 21, 2011 in East Peoria, Illinois. Joy Duling, Interim Executive Director of the Central Illinois Health Information Exchanges, explains how a Health Information Exchange works. Duling is introduced by Dr. Gail Amundson, President and CEO of Quality Quest for Health of Illinois.
Pharmacy Essentials for HIV Screening and Management.2019hivlifeinfo
Pharmacy Essentials for HIV Screening and Management
This downloadable slideset provides an in-depth review of key pharmacy strategies for expanding and supporting safe and effective HIV screening and treatment services to patients at risk of or living with HIV infection.
Jennifer Cocohoba Headshot
Jennifer Cocohoba, PharmD
Format: Microsoft PowerPoint (.ppt)
File Size: 1.93 MB
Released: January 31, 2019
PICOTIn hospitalized medsurg patients , does med reconciliatio.docxstilliegeorgiana
PICOT:
In hospitalized med/surg patients , does med reconciliation compliance compared to non-compliant medication reconciliation impact 30 day readmission rates?
During Unit 5, you will be working on the following unit outcomes:
· Identify levels of measurement in data collection instruments (CO 2)
· Discuss the implications of levels of measurement for statistical analysis (CO 2)
· Appraise the validity and reliability of data collection methods (CO 4)
· Examine data collection methods in published research studies (C
Here is some more information on variables...
The dependent variable is the variable a researcher is interested in. The changes to the dependent variable are what the researcher is trying to measure with all their fancy techniques. The variable that depends on other factors that are measured.
An independent variable is a variable believed to affect the dependent variable. This is the variable that you, the researcher, will manipulate to see if it makes the dependent variable change. The variable that is stable and unaffected by other variables you are trying to measure. It is the presumed cause.
According to Tappen (2016), the independent variables are defined as the variables that the researcher will manipulate to see if a change occurs in the dependent variables. The independent variable is the presumed cause of change. The dependent variables are what the researcher is attempting to measure.
WEEK 4
Ethical concerns in nursing research often do not have straight forward solutions. Nursing research relies on collaboration and partnerships based on mutual trust. When that trust is breached the damage is irreversible. Honesty, openness, respect and sensitivity to others provide the cornerstones for ethical research. It is important that all nursing research is undertaken from a clear ethical stance, with ethical concerns identified at the outset and reevaluated on an ongoing basis throughout the project.
Take a look at this video about ethical issues and human subjects (9:38)
https://www.youtube.com/watch?v=-O5gsF5oyls (Links to an external site.)
As nurses, our primary observations are of persons thus we need to think about how to ethically collect data from persons.
The National Research Act of 1974 established three ethical principles for research:
· Respect for persons
· Beneficence
· Justice
· Check out this video on Types of Sampling Methods ---
· https://www.youtube.com/watch?v=pTuj57uXWlk
Carmen,
· Probability sampling is the gold standard for ensuring generalizability, as it uses some form of random selection in choosing the sample units. The reason that this sample is called a probability sample is each sampling unit has a known chance (probability) that it will be selected (Houser, 2018). Nonprobability sampling does not use random selection so there is no known chance of being selected (Houser, 2018). Nonprobability samples are selected by nonrandom methods. They are often called convenience samples, as the sel ...
Hospital treated pneumonia - Diagnosis and TreatmentBostonsp
In 2014, US healthcare spending exceeded $3.0 trillion with nearly 1/3 spent on hospitalizations. Informed by real-world data from an Electronic Health Record (EHR) database of clinical and administrative records spanning 273 million encounters for 60 million patients in 600+ hospitals across the US, Boston Strategic Partners (BSP) Clinical Insights report, Hospital-Treated Pneumonia, estimates 30% of all hospital discharges involve treatment of infectious organisms. Pneumonia is responsible for an estimated 12% of all hospital stays. At an average cost of $15,500 per occurrence, we estimate that hospitalizations for severe infections account for around $212 billion in annual spending or 7% of total healthcare expenditure. In this report, we conduct an in-depth analysis of pneumonia patient characteristics, medication management, costs, and laboratory testing.
Hospital-Treated Pneumonia is available at www.bostonsp.com/reports.
Gram-negative bacteria are the likely causative agents of most pneumonia infections and physicians treat most of these patients with levofloxacin, ceftriaxone, and azithromycin. From 2010-2015, drug resistant organisms caused a surprising 20% of bacterial pneumonia infections.
This report provides quantitative, objective data captured by hospitals contributing to Cerner Health Facts. This data provides real-world patient encounters and reflects real physician decisions and encounter characteristics (e.g. patient response to therapy and outcomes) in key areas, such as antibiotic resistant pathogens and antimicrobial stewardship.
Michael Ison - USA -Tuesday 29 - Donor Riskincucai_isodp
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This document summarizes work by the MIT Center for Biomedical Innovation on analyzing the cell and gene therapy pipeline. It estimates that there will be approximately 80-100 new gene and cell therapy product approvals in the United States by 2031, treating around 410,000-550,000 patients. The majority of these therapies will be for oncology (cancer) patients. It also provides estimates of total reimbursement for these new therapies in 2031 of $20-30 billion, with $15-21 billion for oncology treatments. Near term therapies discussed include already approved CAR-T cancer therapies and gene therapies for rare diseases like spinal muscular atrophy.
The document recommends continuing to use the Post-Discharge Questionnaire (PDQ) on Unit P7 to assess patient satisfaction and gather data in real-time. Results from the PDQ administered in June 2011 to 101 discharged patients on Unit P7 showed high patient satisfaction scores above the 80th percentile for most discharge measures. Scores were below the 80th percentile for information provided in the discharge packet. The PDQ provided a larger sample size than other surveys and captured feedback that can be used to improve the discharge process.
This document summarizes the work of Dr. Elizabeth Alpern and the Pediatric Emergency Care Applied Research Network (PECARN) to develop an emergency care visit registry using data from electronic health records. The registry collects over 60 quality performance measures across multiple pediatric emergency departments. It provides timely reports to individual clinicians and sites on their performance benchmarks compared to peers. The registry data has been used to study topics like antibiotic prescribing patterns and identify opportunities to improve sepsis screening and management. The goal is to continuously evaluate and improve pediatric emergency care through data-driven quality improvement efforts.
Pediatric Adverse Drug Events PresentationJordan Gamart
This document summarizes a webinar on pediatric adverse drug events hosted by the Patient Safety Movement Foundation. The webinar featured presentations from Dr. Anne Lyren on Children's Hospitals' Solutions for Patient Safety and Dr. James Broselow on eBroselow. Dr. Lyren discussed strategies to reduce pediatric adverse drug events through programs, checklists, and technology. Dr. Broselow discussed how assistive technologies can help standardize and simplify drug administration in pediatrics to reduce errors through features like dose verification and guidelines. The webinar provided an overview of initiatives and tools to help hospitals improve pediatric safety.
Urology practices may be well positioned to serve as medical homes according to a new study. Researchers examined data on urology practices and other specialties and found that urology practices outperformed other surgical and medical specialties on structural elements of the medical home model such as care coordination and quality improvement. Nearly three-quarters of urology practices meet standards for medical home recognition compared to just half of other specialty practices. Additionally, a new care coordination system for patients with hematuria was found to improve quality of care by decreasing time to evaluation completion and increasing efficiency through reducing total urology visits. Finally, regions with lower physician density were found to have higher mortality rates for renal cancer, suggesting decreased access to care impacts
Physician density may correlate to worse urologic cancer outcomes according to a study examining cancer mortality rates. The study analyzed cancer mortality rate data from the CDC and found significantly higher renal cancer mortality rates in areas with low physician density. Additionally, there was a negative association between median family income and bladder and renal cancer mortality rates. The study compared counties with the highest and lowest mortality rates for prostate, bladder, and renal cancers and found those with high rates had significantly lower physician population densities and higher rates of residents without health insurance compared to low mortality rate counties.
Similar to HHC Integration of HIV Testing Within Routine Care (20)
HHC Integration of HIV Testing Within Routine Care
1. 1
Integration of HIV Testing Within
Routine Care in a Large Public Hospital
System
Joanna Omi
Senior Assistant Vice President
Corporate Planning and HIV Services
New York City Health and Hospitals Corporation
New York, NY
November 6, 2007
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
2. 2
Topics covered
• Overview of HIV and the HIV Testing
Expansion Initiative
• Corporatewide and facility results
• Lessons learned
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
3. 3
8.2 million people
live in NYC
100,000 of these are
HIV positive and
25,000 do
not
know it
(est.)
HHC serves 1.3 million
New Yorkers each year
It can be extrapolated that
each year approximately 4,000
undiagnosed HIV positive
New Yorkers access services
at an HHC facility
HHC is in the epicenter of the national
HIV/AIDS epidemic
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
4. 4
New York City Health and Hospitals
Corporation (HHC)
• Public benefit corporation created in 1969
• Largest municipal healthcare delivery system in US
– 11 acute care hospitals with State Designated AIDS
Centers
– 6 diagnostic and treatment centers (D&TCs)
– 4 long-term care hospitals
– 95 extension clinics
– MetroPlus (health maintenance organization)
– Partnership in Care (HIV-specific managed care plan)
– Home care agency
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
5. 5
HHC, continued
• 1.3 million New Yorkers served
• 224,300 discharges
• 4,934,600 visits
• $5.5B operating budget
• Approximately 19,000 patients with
HIV/AIDS
Note: FY07 Data
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
7. 7
HIV Testing Expansion Initiative:
Integrate HIV testing within routine medical care
• Increase the number of patients who know
their HIV status
• Test 150,000 unique patients (increased from 100,000
in FY06)
• Increase the proportion of patients who enter
care early
• Reduce the number of concurrent AIDS diagnoses
• Once in care, retain patients in care
• >80% of patients will have 2 medical visits in the last 12
months, with at least one visit in the last 6 months
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
9. 9
The percentage of unique patients tested at
HHC hospitals steadily increased while
overall volume remained stable
FY05 outpatient and ED Pilot Sites Only (Source: PLM and Pilot Project Sites Reports)
FY06-FY07 outpatient, inpatient and ED (Source: PLM and Facility Reports)
3%
6%
7%
5%
7%
7%
5%
7%
10%
5%
4%
6%
5%
7%
9%
9%
9%
11%
11%
11%
10%
9%
7%
9%
8%
14%
13%
17%
12%
13%
15%
18%
15%
16%
8%
13%
0%
2%
4%
6%
8%
1 0%
1 2%
1 4%
1 6%
1 8%
2 0%
B ell C IH E lm H ar l Jac K C H L in c M e t N C B Q n s W o od A ll
A cu t es
%ofvolumetested
F Y 05 FY 0 6 F Y 07
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
10. 10
The percentage of unique patients tested at
D&TCs steadily increased while overall
volume remained stable
FY05 outpatient and ED Pilot Sites Only (Source: PLM and Pilot Project Sites Reports)
FY06-FY07 outpatient, inpatient and ED (Source: PLM and Facility Reports)
14%
12%
10%
6%
10%
10%
9%
13%
11%
12%
7%
12%
19%
11%
28%
13%
16%
10%
17%
23%
16%
0%
5%
10%
15%
20%
25%
30%
B e lv C u m b E N Y G ou v M o rr R en A ll D & T C s
%ofvolumetested
FY 05 FY 0 6 F Y 07
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
11. 11
9 2,12 3
62 ,023
13 3,8 59
0
30,0 00
60,0 00
90,0 00
1 20,0 00
1 50,0 00
F Y 05 F Y 06 F Y 07
Numberofuniquepatientstested
U n iq u e P re n ata l T e st s A ll O th e r U n iq u e T ests
The number of unique patients tested grew
while prenatal testing remained relatively
stable
FY05 All other unique tests outpatient and ED Pilot Sites Only (Source: PLM and Pilot Project Sites Reports)
FY06-FY07 All other unique tests outpatient, inpatient and ED (Source: Facility Reports)
FY05-FY07 Unique prenatal tests prenatal clinics only (Source: Siemens Data Warehouse)
45.3%
48.5%
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
12. 12
Rapid HIV testing comprised the majority of
unique tests conducted in FY06 and FY07
FY05 outpatient and ED Pilot Sites Only (Source: PLM and Pilot Project Sites Reports)
FY06-FY07 outpatient, inpatient and ED (Source: Facility Reports)
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Q1 Q 2 Q 3 Q 4 Q 1 Q2 Q 3 Q 4 Q 1 Q2 Q3 Q 4
NumberofUniquePatientsTested
C on vention al R H T
FY 05 FY 06 FY 0 7
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
13. 13
But the use of rapid testing varied widely
across facilities
FY07 outpatient, inpatient and ED (Source: Facility Reports)
74%
100%
96%
99%
59%
100%
68%
100%
98%
35%
99%
90%
64%
99%
73%
95%
91%
26%
0%
4%
1%
41%
0%
32%
0%
2%
65%
1%
10%
36%
1%
27%
5%
9%
0%
20%
40%
60%
80%
100%
Bell Belv CIH Cumb Elm ENY Gouv Harl Jac KCH L inc M et M orr NC B Qns R enn Wood
%oftotaltestsbytechnology
RHT Conv
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
14. 14
Patients in Care, Prevalence,
Incidence and Venues
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
15. 15
People of color continue to represent the
largest percentage of unique HIV positive
patients in care…
FY06-FY07 All Venues (Source: PLM Database)
5%5 %
3 5%
53 %
1 %
5%4%
35%
54 %
1%
0
2,00 0
4,00 0
6,00 0
8,00 0
1 0,00 0
1 2,00 0
1 4,00 0
1 6,00 0
1 8,00 0
2 0,00 0
A S IA N B L A C K H IS P A N IC O T H E R W H IT E G r an d T ota l
HIVpatientsincarebyrace
FY 06 A ll V en u es FY 07 A ll V en u es
100 %10 0%
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
16. 16
While men continue to represent the largest
number of unique HIV positive patients in
care
FY06-FY07 All Venues (Source: PLM Database)
6 1 %
3 9 %
6 1 %
3 9 %
0
2 ,0 0 0
4 ,0 0 0
6 ,0 0 0
8 ,0 0 0
1 0 ,0 0 0
1 2 ,0 0 0
1 4 ,0 0 0
1 6 ,0 0 0
1 8 ,0 0 0
2 0 ,0 0 0
F E M A L E M A L E G ra n d T o ta l
HIVpatientsincarebysex
F Y 0 6 A ll V en u es F Y 0 7 A ll V en u es
1 0 0 %1 0 0 %
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
17. 17
Both the total number of unique patients who
tested HIV positive and the subgroup newly
diagnosed with HIV increased in FY07
FY06-FY07 outpatient, inpatient and ED (Source: Facility Reports)
1,514
774
1,630
8 64
0
20 0
40 0
60 0
80 0
1,00 0
1,20 0
1,40 0
1,60 0
1,80 0
All Pa tients w /HIV Po sitive R esults New ly Dia gnosed HIV Po sitiv e Pa tients
FY06 FY07
TotalHIVpositiveandnewlydiagnosed
8%
12%
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
18. 18
Most networks focused their expansion efforts in
the outpatient and ED areas
FY07 outpatient, inpatient and ED (Source: Facility Reports)
87%
66%
74%
68%
54%
78%
71%
69%
9% 9%
4%
8% 7%
4%
12%
8%
4%
25%
21%
25%
39%
19% 18%
24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
C. Bkln Gen + N. Brx N. Bkln Qns S. Bkln S. Man. Corp.
%oftotaltestsbyvenue
Outpatient Inpatient ED
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
19. 19
Across all networks, prevalence was highest
in inpatient units
FY07 outpatient, inpatient and ED (Source: Facility Reports)
1%
1%
1 %
2%
1%
0 %
2%
1%
6%
3%
6 %
4%
3%
4 %
5%
4%
4 %
1%
1%
1 %
1% 1%
2 %
1%
0 %
1 %
2 %
3 %
4 %
5 %
6 %
7 %
C. Bkln G en + N . Brx N. Bkln Qns S. Bkln S . M an. C orp.
HIVprevalencebyvenue
OP IP ED
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
20. 20
As was the percentage of newly diagnosed HIV
positive patients
FY07 outpatient, inpatient and ED (Source: Facility Reports)
0 .6%
0.4 %
0.3%
0 .6%
0.4 %
0.3%
0 .6%
0.5 %
4 %
1%
3%
2 %
2%
4 %
2%
2%
2.2%
0 .9% 0.8 %
1.1%
0.4%
0.5 %
0 .9%
0.8%
0%
1%
2%
3%
4%
5%
C. Bkln G en + N . Brx N. Bkln Qns S. Bkln S . M an. C orp.
HIVPrevalencebyvenue
OP IP ED
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
21. 21
Preliminary utilization data suggest the proportion of
newly HIV positive individuals may be greater in HHC
than in the city as a whole
FY07 outpatient, inpatient and ED (Source: Facility Reports)
NYC Incidence (Source: NYCDOHMH HIV Incidence Estimates Using STARHS – the serologic testing algorithm for recent
HIV seroconversions. CROI poster 2/2007)
NYC Prevalence (Source: NYC HIV/AIDS Annual Surveillance Statistics. 12/2006)
HHC Incidence
0.76%0.45%
2.02%
0%
1%
2%
3%
4%
Outpatient Inpatient ED
HHC Prevalence
3.78%
0.98% 1.08%
0%
1%
2%
3%
4%
Outpatient Inpatient ED
HHC Prevalence = 1.22%
NYC Prevalence=1.2%
HHC Incidence = .65%
NYC Incidence = .31%
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
22. 22
Patients newly diagnosed with HIV in outpatient areas are
more likely to be scheduled for and keep their first HIV
primary care appointment
FY07 outpatient, inpatient and ED (Source: Facility Reports)
94 %
6 8%
85 % 86 %
90 %
77%
7 9%
84 %
0 %
20 %
40 %
60 %
80 %
1 00 %
O utpatie nt Inpa tien t ED To tal
%ofnewlydxpatientsscheduledandkeepingappointment
A p poin tm en t M a de A ppo intm e nt K e pt
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
23. 23
Of patients newly diagnosed with HIV who kept their
first HIV appointment, fewer were concurrently
diagnosed with AIDS in FY07 vs. FY06
FY06-FY07 outpatient, inpatient and ED (Source: Facility Reports)
25 %
54 %
3 6%
32 %
1 6%
32 %
2 3%
21 %
0%
1 0%
2 0%
3 0%
4 0%
5 0%
6 0%
O u tp atie n t I n p a tien t E D T o tal
F Y 06 F Y 07
ProportionofNewHIVdxconcurrentlydxAIDSbyvenue
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
24. 24
Accomplishments
• Large-scale implementation led to the identification of a
significant number of individuals who would not likely
otherwise have taken the opportunity to test.
• Rapid HIV testing is now available at all HHC acute care
hospitals and D&TCs (17 sites).
• All HHC acute care hospitals now offer HIV testing in
multiple venues: ED, inpatient units and at least three
outpatient clinics (including Dental, Medicine, Women’s
Health Services, Adolescent Health Services and Chemical
Dependency).
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
25. 25
Variables that impact the expansion of
testing across HHC
Drivers
– Widespread use of a rapid, easy-to-use HIV test
– Consistent use of the streamlined HIV counseling model
with regular monitoring and evaluation
– Clinical and executive level commitment to expand testing
within the facilities
Inhibitors
– Number of clinicians offering and conducting testing at
some facilities
– Availability of interdisciplinary teams 24/7
– Dedicated space for counseling HIV-positive patients in all
venues
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
26. 26
Data Caveats
• FY05 testing data represents outpatient and ED Pilot Sites
only.
• Data for FY06 and FY07 HIV-positive patients in care reflects
patients connected to care at the time of report and does not
capture patients who may have entered care at a later date.
• The number of unique patients tested for HIV is based on
patient self-report and facility medical records.
• Identification of ‘new diagnosis’ is based on patient self-report
and facility medical records.
• Medical records are unique to each facility and in some cases,
networks. It is possible in some instances that counts are not
unduplicated between sites.
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
27. 27
Summary messages
• Encouraging patients to know their HIV status is a
message that resonates with health care professionals.
• The presence of clinician champions and well
functioning, interdisciplinary teams can significantly
improve testing rates.
• Inpatient testing provides significant opportunities as well
as challenges in complex teaching facilities.
• Best practices for successful expansion of HIV testing
will look different at each facility – one size does not fit
all.
• HHC - facilities and centrally - will continue to examine
the data being generated to inform long-term direction
and other service and policy implications.
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org
28. 28
Acknowledgements and Appreciation
Terry Hamilton, Director of HIV Services, HHC
Drew De Los Reyes, Senior Management Consultant, HHC
Jay Gabor, Senior Management Consultant, HHC
Judy Aberg, MD, Medical Director of HIV Services, Bellevue
Hospital Center and the HHC South Manhattan Network
The dedicated physicians, nurses, administrators,
patient care associates, HIV counselors,
phlebotomists, lab directors and many others
throughout HHC who have contributed to the HIV
testing expansion effort
Copyright 2007, Joanna Omi, Joanna.Omi@nychhc.org