ESTIMATING THE VALUE OF DATA INTEGRATION FOR IMPROVING RETENTION IN HIV PRIMARY CARE

Purpose: Persons living with HIV (PLWH) who receive regular medical care have greater survival and higher likelihood of viral suppression compared to individuals inconsistently engaged in care. However, most recent national estimates indicate that only 53.8% of PLWHs are fully retained in care. One challenge to improving retention is identifying which patients are truly out of care, as healthcare providers are rarely informed when a patient receives care elsewhere, relocates, or dies. Some of this information is captured by state HIV surveillance data, but is not routinely shared with providers. The goal of this analysis is to estimate the value of real-time integration of HIV surveillance data with clinic electronic medical records (EMRs) to better target re-engagement efforts.

Methods: EMR data of HIV-infected patients ≥18 years-old seen at a public, hospital-based clinic in Minneapolis, MN from 2008-2014 were merged with state surveillance data on HIV-related laboratory tests, out-of-state relocation, and mortality. We then estimated the resources required to operate a hypothetical re-engagement program in this patient population. Under the program, we assumed that clinic staff would initiate case investigations for patients exceeding a given time threshold since their last clinical encounter, unless the clinic had been informed that the patient had moved, changed providers, or died. We varied the time threshold for being out of care from 8-24 months. For each threshold, we calculated the total number of required case investigations over the study period with and without surveillance data integration and the number of case investigations averted due to data integration.

Results: For a patient population of 2,194, the number of required case investigations in 2008-2014 using clinic data alone ranged from 1,945 to 592, using 8- and 24-month thresholds, respectively (Figure). For a 12-month threshold, a common definition of retention, surveillance data averted 29.4% of the 1,124 case investigations that would have been conducted with clinic data alone. The proportion of investigations averted with surveillance data increased with the time threshold for initiating a case investigation, reaching a maximum of 44.3% investigations averted for a 24-month threshold.

 

Conclusions: Integrating clinic and surveillance data greatly improved the efficiency of efforts to re-engage HIV patients back into primary care by avoiding unnecessary case investigations for patients who appeared out of care, but were not.