Evaluation of the Sustainability of an Intervention to Increase HIV Testing

BACKGROUND Sustainability—the routinization and institutionalization of processes that improve the quality of healthcare—is difficult to achieve and not often studied. OBJECTIVE To evaluate the sustainability of increased rates of HIV testing after implementation of a multi-component intervention in two Veterans Health Administration healthcare systems. DESIGN Quasi-experimental implementation study in which the effect of transferring responsibility to conduct the provider education component of the intervention from research to operational staff was assessed. PATIENTS Persons receiving healthcare between 2005 and 2006 (intervention year) and 2006 and 2007 (sustainability year). MEASUREMENTS Monthly HIV testing rate, stratified by frequency of clinic visits RESULTS The monthly adjusted testing rate increased from 2% at baseline to 6% at the end intervention year and then declined reaching 4% at the end of the sustainability year. However, the stratified, visit-specific testing rate for persons newly exposed to the intervention (i.e., having their first through third visits during the study period) increased throughout the intervention and sustainability years. Increases in the proportion of visits by patients who remained untested despite multiple, prior exposures to the intervention accounted for the aggregate attenuation of testing during the sustainability year. Overall, the percentage of patients who received an HIV test in the sustainability year was 11.6%, in the intervention year 11.1%, and in the pre-intervention year 5.0% CONCLUSIONS Provider education combined with informatics and organizational support had a sustainable effect on HIV testing rates. The effect was most pronounced during patients' early contacts with the healthcare system.Health Services Research & Development Service (SDP 06–001

Interdisciplinary Transgender Veteran Care: Development of a Core Curriculum for VHA Providers

Purpose: The Veteran\u27s Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program\u27s structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network-Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge

Introductory statistics using SPSS

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Utilizing the ECHO Model in the Veterans Health Affairs System: Guidelines for Setup, Operations and Preliminary Findings

Background: In 2011, the Veterans Health Administration (VHA) consulted with the Project ECHO (Extension for Community Healthcare Outcomes) team at the University of New Mexico, Albuquerque, to reproduce their successful model within the VHA. Methods: The VHA launched SCAN-ECHO (Specialty Care Access Network-Extension for Community Healthcare Outcomes), a multisite videoconferencing system to conduct live clinical consultations between specialists at a VHA Medical Center (hospital) and primary care providers stationed at satellite VHA CBOCs (Community-Based Outpatient Clinic). Results: Analysis of the first three years rendered a mean attendee satisfaction of 89.53% and a consultation satisfaction score of 88.10%. About half of the SCAN-ECHO consultations resulted in patients receiving their treatment from their local primary care providers; the remaining half were referred to the VHA Medical Center when the treatment involved equipment or services not available at the CBOCs (e.g., MRI, surgery). Conclusion: This paper details the setup, operation logistics and preliminary findings, suggesting that SCAN-ECHO is a viable model for providing quality specialty clinical consultation service, prompter access to care, reduced commutes and continuing education. Additionally, the use of a secured Internet-based videoconferencing system that supports connectivity to multiple (mobile) devices could expand the utilization of this service

Human Trafficking Readiness for Clinicians: Content Validation of a Survivor Co-Led Education Program

Purpose. This project validates knowledge and confidence in nurses/clinicians who could encounter human trafficking (HT). Background. HT, a worldwide problem, is the exploitation of human beings. There are up to 40 million victims globally and 18,000-20,000 in the US. Many victims encounter healthcare professionals who often lack HT training. Methods. Clinicians/HT survivors led trainings at two Northern California hospitals. Ability to identify/treat HT patients was measured before and after training. Results. 254 professionals, (73.9% nurses) participated. Despite 66.1% indicating HT could affect their patients, most lacked HT identification/treatment training. At baseline, 26.3% of participants felt comfortable/very comfortable identifying and treating potential victims of human trafficking, compared to 93.2% (p < .001) and 90.4% (p < .001), respectively, at posttest. Implications. The training improved red-flag identification and documentation and expanded the trauma-informed care approach. Prioritizing departments likely to serve trafficked patients, this program was implemented across our three-state hospital system

Evaluation of the Sustainability of an Intervention to Increase HIV Testing

Sustainability—the routinization and institutionalization of processes that improve the quality of healthcare—is difficult to achieve and not often studied. To evaluate the sustainability of increased rates of HIV testing after implementation of a multi-component intervention in two Veterans Health Administration healthcare systems. Quasi-experimental implementation study in which the effect of transferring responsibility to conduct the provider education component of the intervention from research to operational staff was assessed. Persons receiving healthcare between 2005 and 2006 (intervention year) and 2006 and 2007 (sustainability year). Monthly HIV testing rate, stratified by frequency of clinic visits. The monthly adjusted testing rate increased from 2% at baseline to 6% at the end intervention year and then declined reaching 4% at the end of the sustainability year. However, the stratified, visit-specific testing rate for persons newly exposed to the intervention (i.e., having their first through third visits during the study period) increased throughout the intervention and sustainability years. Increases in the proportion of visits by patients who remained untested despite multiple, prior exposures to the intervention accounted for the aggregate attenuation of testing during the sustainability year. Overall, the percentage of patients who received an HIV test in the sustainability year was 11.6%, in the intervention year 11.1%, and in the pre-intervention year 5.0% Provider education combined with informatics and organizational support had a sustainable effect on HIV testing rates. The effect was most pronounced during patients’ early contacts with the healthcare system