Publications

PURPOSE

The objective of this paper is to describe how members of HIV patients' care teams perceived the usefulness and ease of use of newly implemented, innovative health information exchange systems (HIEs) in diverse HIV treatment settings. Five settings with existing electronic medical records (EMRs) received special funding to test enhancements to their systems. Participating clinics and community-based organizations added HIEs permitting bi-directional exchange of information across multiple provider sites serving the same HIV patient population.

METHODS

We conducted in-depth qualitative interviews and quantitative web-based surveys with case managers, medical providers, and non-clinical staff members to assess the systems' perceived usefulness and ease of use shortly after the HIEs were implemented. Our approach to data analysis was iterative. We first conducted a thematic analysis of the qualitative data and discovered that there were key differences in perceptions and actual use of HIEs across occupational groups. We used these results to guide our analysis of the quantitative survey data, stratifying by occupational group.

RESULTS

We found differences in reports of how useful and how well-used HIEs were, by occupation. Medical providers were more likely to use HIEs if they provided easier access to clinical information than was present in existing EMRs. Case managers working inside medical clinics found HIEs to be less helpful because they already had access to the clinical data. In contrast, case managers working in community settings appreciated the new access to patient information that the HIEs provided. Non-clinical staff uniformly found the HIEs useful for a broad range of tasks including clinic administration, grant writing and generating reports for funders.

CONCLUSION

Our study offers insights into the use and potential benefits of HIE in the context of HIV care across occupational groups.

PURPOSE

The purpose of this article is to describe how comprehensive HIV care is delivered within Ryan White Program (RWP)-funded clinics and to characterize proposed health information exchange (HIE) interventions, which employ technology to exchange information among providers, designed to improve the quality and coordination of clinical and support services.

METHODS

We use HIV patient care quality and coordination indicators from electronic data systems to describe care delivery in six RWP demonstration sites and describe HIE interventions designed to enhance that care.

RESULTS

Among patients currently in care, 91% were retained in care in the previous six months (range across sites: 63-99%), 79% were appropriately prescribed antiretroviral therapy (54-91%) and 52% had achieved undetectable HIV viral load (16-85%). To facilitate coordination of care across clinical and support services, sites designed HIE interventions to access a variety of data systems (e.g. surveillance, electronic health records, laboratory and billing) and focused on improving linkage and retention, quality and efficiency of care and increased access to patient information.

DISCUSSION

Care quality in RWP settings can be improved with HIE tools facilitating linkage, retention and coordination of care. When fully leveraged, HIE interventions have the potential to improve coordination of care and thereby enhance patient health outcomes.

BACKGROUND

Rifapentine administered 5 days per week has potent activity in mouse models of antituberculosis chemotherapy, but efficacy and safety data are limited in humans. We compared the antimicrobial activity and safety of rifapentine vs rifampin during the first 8 weeks of pulmonary tuberculosis treatment.

METHODS

In total, 531 adults with sputum smear-positive pulmonary tuberculosis were randomized to rifapentine 10 mg/kg/dose or rifampin 10 mg/kg/dose, administered 5 days per week for 8 weeks (intensive phase), with isoniazid, pyrazinamide, and ethambutol. Coprimary outcomes were negative sputum culture on liquid and on solid media at completion of intensive phase.

RESULTS

Negative cultures on solid media occurred in 145 of 174 participants (83.3%) in the rifampin group and 171 of 198 participants (86.4%) in the rifapentine group (difference, 3.0%; 95% confidence interval [CI]: -4.3, 10.5); negative cultures in liquid media occurred in 110 of 169 (65.1%) in the rifampin group and 133 of 196 (67.9%) in the rifapentine group (difference, 2.8%; 95% CI: -6.9, 12.4). Among 529 participants who received study therapy, 40 of 254 participants (15.7%) in the rifampin group and 40 of 275 participants (14.5%) in the rifapentine group prematurely discontinued treatment (P=.79).

CONCLUSIONS

The rifapentine regimen was safe but not significantly more active than a standard rifampin regimen, by the surrogate endpoint of culture status at completion of intensive phase. Assessment of higher exposures to rifapentine for tuberculosis treatment is warranted.

CLINICAL TRIALS REGISTRATION

NCT00694629.