title: Assessment and improvement of HIV screening rates in a Midwest primary care practice using an electronic clinical decision support system: a quality improvement study.
abstract: Universal human immunodeficiency virus (HIV) screening remains low in many clinical practices despite published guidelines recommending screening for all patients between ages 13-65. Electronic clinical decision support tools have improved screening rates for many chronic diseases. We designed a quality improvement project to improve the rate of universal HIV screening of adult patients in a Midwest primary care practice using a clinical decision support tool.
  
  
  
  We conducted this quality improvement project in Rochester, Minnesota from January 1, 2014 to December 31, 2014. Baseline primary care practice HIV screening data were acquired from January 1, 2014 to April 30, 2014. We surveyed providers and educated them about current CDC recommended screening guidelines. We then added an HIV screening alert to an existing electronic clinical decision support tool and post-intervention HIV screening rates were obtained from May 1, 2014 to December 31, 2014. The primary quality outcome being assessed was change in universal HIV screening rates.
  
  
  
  Twelve thousand five hundred ninety-six unique patients were eligible for HIV screening in 2014; 327 were screened for HIV. 6,070 and 6,526 patients were seen before and after the intervention, respectively. 1.80 % of eligible patients and 3.34 % of eligible patients were screened prior to and after the intervention, respectively (difference of -1.54 % [-2.1 %, -0.99 %], p < 0.0001); OR 1.89 (1.50, 2.38). Prior to the intervention, African Americans were more likely to have been screened for HIV (OR 3.86 (2.22, 6.71; p < 0.001) than Whites, but this effect decreased significantly after the intervention (OR 1.90 (1.12, 3.21; p = 0.03).
  
  
  
  These data showed that an electronic alert almost doubled the rates of universal HIV screening by primary care providers in a Midwestern practice and reduced racial disparities, but there is still substantial room for improvement in universal screening practices. Opportunities for universal HIV screening remain abundant, as many providers either do not understand the importance of screening average risk patients or do not remember to discuss it. Alerts to remind providers of current guidelines and help identify screening opportunities can be helpful.
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. marcelin.jasmine@mayo.edu.
authors.forename: Jasmine R
authors.initials: JR
authors.lastname: Marcelin
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Tan
authors.affiliation: Department of Family Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Marcelin
authors.affiliation: Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Scheitel
authors.affiliation: Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Praveen
authors.initials: P
authors.lastname: Ramu
authors.affiliation: Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Hankey
authors.affiliation: Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Pritesh
authors.initials: P
authors.lastname: Keniya
authors.affiliation: Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Majken
authors.initials: M
authors.lastname: Wingo
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Rizza
authors.affiliation: Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: North
authors.affiliation: Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Chaudhry
mesh_terms: D000293:Adolescent; D000328:Adult; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D055815:Young Adult
keywords: Clinical decision support systems; HIV; Quality improvement; Universal screening