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Author List:
Goetz M
Holodniy M
Rigsby M
Objectives:
Guidelines for who should be tested for HIV drug resistance are generally followed within the VA, however, not only is there considerable variation in the types of tests performed but also in the manner that test results are provided to clinicians. This becomes problematic for making appropriate treatment decisions. Towards designing a more usable report for a future QUERI-HIV implementation project, we first sought to characterize current practice variations and clinician needs.
Methods:
QUERI-HIV investigators and the Public Health Strategic Healthcare Group, in collaboration with Pathology and Laboratory Medicine Service, surveyed laboratory managers and one lead HIV provider at 127 VA facilities in May 2003 regarding local practices for obtaining and reporting HIV drug resistance test results.
Results:
Only 43% of sites enter resistance test results in CPRS, along with other lab results. Furthermore, 20% of sites use CPRS only to indicate that a test has been done while 19% do not enter these results in CPRS at all. The remaining sites reported other practices. Of the sites that do enter these data in CPRS, only 68% provide resistance mutations and an interpretation of drug susceptibility; both are critical pieces of information. Further, 56% of providers indicated at least some degree of difficulty in retrieving the results and 36% agreed that changes are needed in the way they are reported and recorded.
Implications:
The absence of a consistent system to capture complete results and to clearly present them to clinicians is a barrier to quality care delivery. On the basis of this survey, we clearly see the need for a better, more consistent means to ensure that the full results of HIV resistance tests are reported within CPRS. Toward that goal, we plan to develop an enhanced report that will provide resistance test results in CPRS within the context of other essential data for making the best treatment choices. Accessing the necessary databases and clinical reports to support the enhanced report will require close collaboration between Medical, Informatics, and Research Services.
Impacts:
