Use of a real-time alert system to identify and re-engage lost-to-care HIV patients

1. Use of a real-time alert system to identify and re-engage lost-to-care HIV patients Melanie L. Fritza Ronald J. Lubelchek, MD a, b, c* Katelynne J. Finnegan, MPHa William E. Trick,c, d a. Ruth M. Rothstein CORE Center b. Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County c. Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County d. Collaborative Research Unit, John H. Stroger, Jr. Hospital of Cook County

2. Presenter Disclosures Melanie Fritz No relationships to disclose (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. Introduction HIV new infection rate holding steady since ~2009 MSM 12% (2008-2010) Young MSM 22% (2008-2010) Young, Black MSM 43% (2006-2009)

4. linkage to care and retention in care predict better outcomes Diagnosed Linked to Care Retained in Care Prescribed antiretroviral therapy Virally Suppressed Outcomes Reduced transmission in community Improved patient health

5. An EMR-Based Alert Intervention Patient-navigation based techniques Health information technology

6. Methodology

7. Setting and Patients Included Patients lost to care for over 7 months Ruth M Rothstein CORE CENTER John H Stroger Hospital

8. Registration information transmitted to Collaborative Research Unit server in real time 2 4 Real time alert notifies program staff member Alert Design Query cross references registration information with list of RMR CORE Center lost-to-care patients Clerk registers patient at CCHHS clinical site 3 1 5 Staff log onto password- protected website to access patient and registration event information.

9. Response to Alert ReceiveAlert ChartReview OutreachIntervention

10. Results

11. 398 Alerts Received Repeat alerts 198 (50%) Unique patients 198 (50%) Excluded from analysis 83 (42%) Included in analysis 115 (58%) Appointment already in system 60 (52%) No appointment in the system 55 (48%) Phone outreach 33 (60%) In-person outreach 22 (40%) No Outreach Attempted Contacted 13 (39%) Unable to contact 20 (61%)

12. Table 1: Demographic/clinical characteristics and rate of return-to-care for alert-triggering lost-to-care HIV+ patients

13. Table 1: Demographic/clinical characteristics cont’d

14. Table 2: Logistic regression for associations with not following up for care within three months for lost-to-care HIV+ patients

15. Table 2: Logistic regression cont’d On method of contact In-Person Contact: 86% follow-up Attempted Phone Contact: 58% follow-up

16. Discussion • Scheduling an appointment = more likely to return to care • In-person contact success rate • Phone contact success rate • Conclusion: This is one example of a successful intervention.

17. Limitations • No randomized control group • Moderate number of patients • Located within a single health system

18. Future Opportunities • Utilize alert system as less-intensive intervention • Explore more intensive targeted interventions for harder-to-engage patients • Regional Health Information Exchange with other health systems

19. acknowledgements • HIV Treatment Cascade administrative supplemental funding from the Chicago Developmental Center for AIDS Research (P30 AI 082151, Alan Landay, Principal Investigator). • Anna Hotton, PhD for input on our analysis. • Alex Patino, George Markovski, and Francisco Angulo for building the text messaging and secure website alert system.

20. Thank you! Melanie Fritz mfritz3@cookcountyhhs.org