Background
Routine HIV testing of hospitalized patients is recommended, but few strategies to expand testing in the hospital setting have been described. We assessed the impact of an electronic medical record (EMR) prompt on HIV testing for hospitalized patients.
Methods
We performed a pre-post study at three hospitals in the Bronx, NY. We compared the proportion of admissions of patients 21–64 years old with an HIV test performed, characteristics of patients tested, and rate of new HIV diagnoses made by screening while an EMR prompt recommending HIV testing was inactive vs. active. The prompt appeared for patients with no prior HIV test or a high-risk diagnosis after their last HIV test.
Results
Among 36,610 admissions while the prompt was inactive, 9.5% had an HIV test performed. Among 18,943 admissions while the prompt was active, 21.8% had an HIV test performed. Admission while the prompt was active was associated with increased HIV testing among total admissions (aOR 2.78, 95%CI 2.62–2.96), those without a prior HIV test (aOR 4.03 95%CI 3.70–4.40), and those with a prior negative test (aOR 1.52, 95%CI 1.37–1.68) (p<0.0001 for all). While the prompt was active, testing increased across all patient characteristics. New HIV diagnoses made by screening increased from 8.2/100,000 admissions to 37.0/100,000 admissions while the prompt was inactive and active, respectively (OR 4.51 95%CI 1.17–17.45, p= 0.03).
Conclusions
An EMR prompt for hospitalized patients was associated with a large increase in HIV testing, a diversification of patients tested, and an increase in diagnoses made by screening.