Results

Compliance with Breast Cancer Screening Guidelines in the HIV Clinic:A Quality Improvement Tool

E. Patrozou M.D., E. Christaki M.D., L. Hicks D.O., C. Wang M.D., F. Gillani Ph.D., and K. Tashima M.D. Division of Infectious Diseases, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI

Methods

Background

Methods

Conclusions

1. The Antiretroviral Therapy Cohort Collaboration, Lancet 2008;372:293-99

2 .Sheth et al, AIDS Patient Care STDS 2006;20:318-325

• 52 (23%) of the 223 women had a screening mammogram within the last 12 months before the implementation of the mammogram alert, compared to 71 (32%) women after the alert was instituted (McNemar chi-square, p=0.01)(table 2).

• Private insurance and absolute CD4 count ≥200 were independent factors predicting compliance after the implementation of the quality improvement intervention in a multivariate, logistic regression analysis (p=0.04 for both variables).

• Compliance with mammogram screening was low in a busy ID clinic, however, it improved when providers were reminded that screening was due.

• Alert systems may be used to improve the quality of care for HIV-infected patients.

• We identified N=223 HIV-infected women, > 41 years of age, from our clinic’s electronic database.

• A retrospective review of the electronic and paper charts was conducted and cross-referenced to electronic radiology reports.

• We determined compliance rates with breast cancer screening guidelines before and 6 months after the implementation of a quality improvement intervention that reminded providers when their patient’s screening date was due (figure 1). Multiple demographic and HIV related factors were assessed in a multivariate logistic regression analysis (table 1).

• Infectious Diseases specialists often assume the role of primary care physician for HIV patients. As life expectancy of HIV patients has dramatically improved over the last two decades,1 the management of chronic non HIV-related diseases and routine health screening has emerged as a new challenge for such health care providers. Prior studies have shown that patients of HIV clinics are more likely to receive HIV-specific interventions as compared to general preventative health services, especially when the service requires referral to another provider or department.2

• The Immunology Center at the Miriam Hospital provides primary and subspecialty care for a large proportion of HIV-infected individuals in Rhode Island. Since its establishment in 1986, it has grown considerably from a specialty program for women to the current census of 1136 patients: 376 women and 760 men.

• The goal of this project was to measure and by using a quality improvement tool improve the adherence to published guidelines for breast cancer screening in HIV-infected women at the Miriam Immunology Center.

References

Table 1: Population Characteristics (N=223)

Age (years), mean ± SD 49.6 ±6.6

Race, n (%)

Caucasian 101 (45%)

African-American 84 (38%)

Alaskan/Native American 3 (1%)

Asian 5 (2%)

More than one Race30 (13%)

Insurance

Private 45 (20%)

Non-private 178 (80%)

HAART

Yes 190 (85%)

No 33 (15%)

Unknown 2 (1%)

CD4 count (cells/μl), mean ± SD 480 ± 298

CD4<200 35 (16%)

CD4≥200 188 (84%)

PVL (copies/ml), mean ± SD 10018 ±34094

PVL<75 137 (61%)

PVL≥75 86 (39%)

Table 2: Compliance with Yearly Mammogram

Before alert 52/223 (23%)

p=0.01After alert 71/223 (32%)