Hospitalization and Emergency Room Visits: The Opportunity for Re-Engagement for People Living with HIV/AIDS (PLWHA)

Abstract

Background

Persons living with HIV/AIDS (PLWHA) who are not engaged in HIV medical care are at greater risk for adverse individual health outcomes, as well as potential transmission to others. Thus, detecting and re-engaging PLWHA who are not in care is a public health priority. Unplanned hospitalizations or Emergency Department (ED) visits provide a potential opportunity to re-engage PLWHA who are out of care. Our Data-to-Care (D2C) pilot project was launched in July 2016 to identify PLWHA in the ED and inpatient settings and subsequently, establish re-engagement in HIV care (RIC) among those out of care.

Methods

Our D2C program leverages electronic health records (EHR) as a mechanism to identify PLWHA and support RIC. An Infectious Diseases social worker (SW) generates an EHR-based report daily to identify PLWHA in the hospital in near real-time, then determines whether a patient currently receives HIV care. If not, the SW meets with the patient to determine needs, insurance status, schedules an HIV care appointment, and provides referrals for wraparound services. SW subsequently confirmed attendance at HIV care appointment. RIC was defined as attending an HIV clinical appointment, and X ² analyses were used to compare differences between RIC and not RIC.

Results

Over a 10-month period, we identified 237 PLWHA seen in the ED or hospitalized. The majority of patients were African-American (AA) (92.7%), male (66.1%) and mean age 44.6 ± 14.6 years old. Of the 237 patients identified, 172 (72.6%) confirmed already in care, 7 (3.0%) deceased, and 2 (0.8%) incarcerated. Among patients eligible for RIC, 44 (73.3%) were contacted by staff, 39 (65.0%) were referred to care, and 32 (53.3%) were RIC. Patients not RIC were all AA, 69.2% male, and mean age 38.5 ± 14.2 years old. Patients identified in the inpatient setting were more likely to be RIC vs. those identified in the ED (81.3% vs. 18.8%, P < 0.01). Interestingly, insurance type was not associated with RIC vs. not RIC ( P = 0.17).

Conclusion

Our pilot program demonstrates the potential for using the EHR to identify PLWHA who are in need of RIC during unplanned hospitalizations and ED visits. Inpatients were more likely to be RIC than ED patients, likely due to the ability to make in-person contact during hospitalization compared with ED visit by SW staff.

Disclosures

D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient