A randomized controlled trial of health information exchange between HIV institutions

Context. In order for patients to benefit from a multidisciplinary treatment approach, diverse providers must communicate on patient care. Objective. We sought to examine the effect of information exchange across multidisciplinary HIV providers on patient health outcomes. Design. Randomized Controlled Trial (RCT), randomized at the patient level. Setting. Six Infectious Disease (ID) clinics paired with nine ancillary care settings (e.g., HIV case management). Participants. 254 patients with HIV receiving care at the ID clinics. Intervention. Health information was exchanged for two years per patient between medical and ancillary care providers using electronic health records (EHRs) and print-outs inserted into charts. Medical providers gave ancillary providers HIV viral loads, CD4 values, current medications, and appointment attendance. Ancillary providers gave medical providers information on medication adherence and major changes (e.g., loss of housing). Main Outcome Measures. We abstracted from medical records HIV viral loads, CD4 counts, and antiretroviral medication prescriptions before and during the intervention. From 0, 12, and 24-month patient surveys, we assessed hospitalizations, Emergency Department (ED) use, and health-related quality of life measured by the SF-36. Results. No statistically significant differences between cases and controls were found across time for: proportion with suppressed viral load; changes in viral load or CD4 values; patients being prescribed antiretroviral medication; hospitalizations; ED visits; or any scale of the SF-36. Trends were mixed but leaned toward better health for control participants. Conclusions. The exchange of this specific set of information between HIV medical and ancillary care providers was neutral on a variety of patient health outcomes.

Duke Scholars

Author Rae Jean Proeschold-Bell Duke Global Health Institute