A randomized controlled trial of health information exchange between human immunodeficiency virus 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 human immunodeficiency virus (HIV) care providers on patient health outcomes. DESIGN: Randomized controlled trial, randomized at the patient level. SETTING: Six infectious disease clinics paired with 9 ancillary care settings (eg, HIV case management). PARTICIPANTS: Two hundred fifty-four patients with HIV receiving care at the infectious disease clinics. INTERVENTION: Health information was exchanged for 2 years per patient between medical and ancillary care providers using electronic health records and printouts inserted into charts. Medical care providers gave ancillary care providers HIV viral loads, CD4 values, current medications, and appointment attendance. Ancillary care providers gave medical providers the information on medication adherence and major changes (eg, 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 use, and health-related quality of life measured by the Medical Outcomes Study Short Form-36 (SF-36). RESULTS: No statistically significant differences between cases and controls were found across time for the following: proportion with suppressed viral load, changes in viral load or CD4 values, patients being prescribed antiretroviral medication, hospitalizations, emergency department 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.
Proeschold-Bell, RJ; Belden, CM; Parnell, H; Cohen, S; Cromwell, M; Lombard, F
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