title: A system-wide intervention to improve HIV testing in the Veterans Health Administration.
abstract: BACKGROUND
  Although the benefits of identifying and treating asymptomatic HIV-infected individuals are firmly established, health care providers often miss opportunities to offer HIV-testing.
  
  
  OBJECTIVE
  To evaluate whether a multi-component intervention increases the rate of HIV diagnostic testing.
  
  
  METHODS
  Pre- to post-quasi-experiment in 5 Veterans Health Administration facilities. Two facilities received the intervention; the other three facilities were controls. The intervention included a real-time electronic clinical reminder that encourages HIV testing, and feedback reports and a provider activation program.
  
  
  METHODS
  Persons receiving health care between August 2004 and September 2006 who were at risk but had not been previously tested for HIV infection.
  
  
  METHODS
  Pre- to post-changes in the rates of HIV testing at the intervention and control facilities
  
  
  RESULTS
  At the two intervention sites, the adjusted rate of testing increased from 4.8% to 10.8% and from 5.5% to 12.8% (both comparisons, p < .001). In addition, there were 15 new diagnoses of HIV in the pre-intervention year (0.46% of all tests) versus 30 new diagnoses in the post-intervention year (0.45% of all tests). No changes were observed at the control facilities.
  
  
  CONCLUSIONS
  Use of clinical reminders and provider feedback, activation, and social marketing increased the frequency of HIV testing and the number of new HIV diagnoses. These findings support a multimodal approach toward achieving the Centers for Disease Control and Prevention's goal of having every American know their HIV status as a matter of routine clinical practice.
authors.affiliation: Infectious Diseases Section (111-F), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. matthew.goetz@va.gov
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Tuyen
authors.initials: T
authors.lastname: Hoang
authors.forename: Candice
authors.initials: C
authors.lastname: Bowman
authors.forename: Herschel
authors.initials: H
authors.lastname: Knapp
authors.forename: Barbara
authors.initials: B
authors.lastname: Rossman
authors.forename: Robert
authors.initials: R
authors.lastname: Smith
authors.forename: Henry
authors.initials: H
authors.lastname: Anaya
authors.forename: Teresa
authors.initials: T
authors.lastname: Osborn
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D015492:AIDS Serodiagnosis / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D017010:Reminder Systems; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014584:User-Computer Interface