title: How Compliance Measures, Behavior Modification, and Continuous Quality Improvement Led to Routine HIV Screening in an Emergency Department in Brooklyn, New York.
abstract: OBJECTIVE
  New York State adopted a new HIV testing law in 2010 requiring medical providers to offer an HIV test to all eligible patients aged 13-64 years during emergency room or ambulatory care visits. Since then, Wyckoff Heights Medical Center (WHMC) in Brooklyn, New York, began implementing routine HIV screening organization-wide using a compliance, behavior-modification, and continuous quality-improvement process.
  
  
  METHODS
  WHMC first implemented HIV screening in the emergency department (ED) and evaluated progress with the following monthly indicators: HIV tests offered, HIV tests accepted, HIV tests ordered (starting in December 2013), HIV tests administered, positive HIV tests, and linkage to HIV care. Compliance with the delivery of HIV testing was determined by the proportion of patients who, after accepting a test, received one.
  
  
  RESULTS
  During August 2013 through July 2014, of 57,852 eligible patients seen in the WHMC ED, a total of 31,423 (54.3%) were offered an HIV test. Of those, 8,229 (26.2%) patients accepted a test. Of those, 6,114 (74.3%) underwent a test. A total of 26 of the 6,114 patients tested (0.4%) had a positive test, and 24 of the 26 HIV-positive patients were linked to HIV medical care. By July 2014, the monthly proportion of patients offered a test was 62%; the proportion of those offered a test who had a test ordered was 98%, and the proportion of those with a test ordered who were tested was 81%. Testing compliance increased substantially at the WHMC ED, from 77% in December 2013 to >98% in July 2014.
  
  
  CONCLUSIONS
  Using compliance-monitoring, behavior-modification, and continuous quality-improvement processes produced substantial increases in offers and HIV test completion. WHMC is replicating this approach across departments, and other hospitals implementing routine HIV screening programs should consider this approach as well.
authors: Wyckoff Heights Medical Center, HIV Testing and Compliance, Brooklyn, NY.
authors: Jermel Kyri
authors: JK
authors: Isaac
authors: Emory University, Rollins School of Public Health, Atlanta, GA.
authors: Travis H
authors: TH
authors: Sanchez
authors: Emory University, Rollins School of Public Health, Atlanta, GA.
authors: Emily H
authors: EH
authors: Brown
authors: Wyckoff Heights Medical Center, HIV Testing and Compliance, Brooklyn, NY.
authors: Gina
authors: G
authors: Thompson
authors: Wyckoff Heights Medical Center, HIV Testing and Compliance, Brooklyn, NY.
authors: Christina
authors: C
authors: Sanchez
authors: Wyckoff Heights Medical Center, HIV Testing and Compliance, Brooklyn, NY.
authors: Stephany
authors: S
authors: Fils-Aime
authors: Wyckoff Heights Medical Center, HIV Testing and Compliance, Brooklyn, NY.
authors: Jose
authors: J
authors: Maria
mesh_terms: D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration; D017749:Total Quality Management / Q000379:methods; D055815:Young Adult