Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities

Abstract

Background Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS) and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes. Methods We used a quasi-experimental, interrupted time series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N=1,181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures included ART pharmacy fill and HIV VL lab data extracted from the medical records over three years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved three-stage, multivariable logistic regression with generalized estimating equations (GEE). Results Overall, the intervention predicted greater odds of ART use (OR=2.50; 95% CI=2.29-2.73; P<0.001) and VS (OR=1.12; 95% CI=1.04-1.21; P<0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Prior to the intervention, there were significant Black/White disparities in ART use OR=0.75 (0.58-0.98; P=0.04) and VS OR=0.75 (0.61-0.92; P=0.001). After the intervention, the Black/White disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than Whites of ART use and VS, adjusting for covariates. Conclusions The intervention improved overall ART treatment and VS, and reduced Black/White disparities. LHIE interventions may hold promise if implemented among similar patients.

Enabling a Learning Public Health System: Enhanced Surveillance of HIV and Other Sexually Transmitted Infections

“…7,8 Prior studies involving HIE use have been associated with both cost and time savings on demographic and treatment requests made by public health staff, 9 decrease in unnecessary diagnostic testing in emergency departments, 10 improved continuity of care and patient outcomes, 11–14 and a reduction in racial and ethnic disparities. 15 Large publicly available datasets offer additional context when data linkages are made based on common geography, an important dimension of social determinants of health (SDOH). 16,17…”

Use of Health Information Exchange in The Continuity of Care as Viewed by Patients and Nurses: A Cross Sectional Study

“…However, despite the global increase in HIE, its use is still limited. Among the barriers that delay the implementation of HIE are concerns about compromising patient privacy and security, the risk of initiating a train of errors, lack of appropriate training to use HIE, personnel resistance to change, di culties with information technology, and a lack of adequate nancial resources [5][6]. Moreover, a systematic review revealed that the most common obstacles to HIE use are the failure of organizations to integrate HIE into the work ow, and missing data.…”

The associations between query‐based and directed health information exchange with potentially avoidable use of health care services

“…The most consistent evidence in support of HIE as a stand‐alone intervention to positively affect health care delivery comes largely from emergency department settings and from studies of specific use cases, such as provider use of repeat and/or appropriate imaging, medication reconciliation, or prescribing behavior . In contrast, studies in ambulatory care settings have been less consistent, ranging from no impact, to mixed results, to some observed improvements in outcomes for specific patient populations . Absence of strong evidence of its effectiveness has been a barrier to broader HIE adoption …”

“…A standard use case for directed exchange is support for care transitions . Overall, directed exchange has been associated with reductions in avoidable utilization and higher quality of care in high‐risk ambulatory care and long‐term care populations …”

“…18,19 In contrast, studies in ambulatory care settings have been less consistent, ranging from no impact, 20 to mixed results, 21,22 to some observed improvements in outcomes for specific patient populations. 23,24 Absence of strong evidence of its effectiveness has been a barrier to broader HIE adoption. 25 In addition, the existing evidence base of the impact of HIE does not adequately distinguish between different technological approaches to HIE.…”