BackgroundThe Center for Disease Control provides recommendations for preventative services and screenings including recommendations for a one-time HIV screening of all adult patients between the ages of 13-64. But not all clinics are fully compliant with these recommendations. We identified a need for increased screening at two clinics in a rural setting. As a healthcare quality improvement initiative, we developed educational informatics to increase screening compliance.MethodsThis project assessed HIV screening rates before and after educational interventions at two clinics, the Coyote Clinic and the Avera Downtown Clinic. Three changes were implemented to increase the HIV screening rate and ultimately provide more effective high-quality health care. The three initiatives focused on patients, physicians, and student volunteers in order to provide a strong foundation of knowledge to all parties involved in a patient’s care.ResultsPrior to any interventions, the baseline screening rate (screenings/100 persons) at the Avera Downtown Clinic was 0.84 while the screening rate at the Coyote Clinic was 0.00. After the proposed interventions, the screening rate of the Downtown Clinic improved to 3.97 and the screening rate at the Coyote Clinic improved to 29.4. Using a Fisher’s Exact test, we found a statistically significant post-intervention increase in HIV screening at the Coyote Clinic after the intervention (p = 0.0002) but not at the Downtown Clinic (p = 0.0940.)ConclusionHIV screening rates improved after the implementation of interventional education initiatives tailored for patients, medical students, and physicians. Implementation of low-cost quality improvement measures such as the ones detailed herein may significantly improve long-term patient management, particularly in the context of screening tests.
For a given skin cancer, a number of treatment options are often available. The decision of which method to use is usually made by the treating physician. Despite significant changes to the healthcare system of the United States over the past ten years, healthcare costs continue to rise. These costs often affect patients in the form of higher deductibles, copays, and insurance premiums. The goal of this study was to determine patient attitudes regarding discussion of cost of skin cancer removal procedures and repairs. A 12-question survey was administered to 100 patients presenting for treatment of a skin cancer at an academic center. The first six questions addressed the importance the patient placed on treatment cost and related discussions, and the final six questions addressed repair cost. Greater than two-thirds of respondents felt that cost of both treatment (76%) and repair (67%) is somewhat or very important. Most patients reported that the cost of skin cancer treatment (56%) and repair (54%) should be considered by their surgeon. Furthermore, a majority of participants felt that cost differences should be discussed prior to treatment (67%) or repair (67%). Most respondents believed that cost discussion prior to treatment (64%) and repair (67%) would not affect their level of procedural anxiety. In conclusion, patients value cost discussions for treatment and repair of skin cancer. Surgeons should consider discussing these issues with patients in the appropriate clinical setting.
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