Electronic Human Immunodeficiency Virus (HIV) Clinical Reminder System Improves Adherence to Practice Guidelines among the University of Washington HIV Study Cohort

Abstract

We conducted a prospective study of an electronic clinical reminder system in an academic medical center-based human immunodeficiency virus (HIV) specialty clinic. Published performance indicators were used to examine adherence to HIV practice guidelines before and after its implementation for 1204 patients. More than 90% of patients received CD₄ cell count and HIV type 1 (HIV-1) RNA level monitoring every 3-6 months during both time periods, and ~80% of patients with a CD₄ cell count nadir of <350 cells/mm³ received highly active antiretroviral therapy. Patients were significantly more likely to receive prophylaxis against 'Mycobacterium avium' complex (hazard ratio, 3.84; 95% confidence interval [CI], 1.58-9.31; 'P'=.003), to undergo annual cervical carcinoma screening (OR, 2.09; 95% CI, 1.04-4.16; 'P'=.04), and to undergo serological screening for Toxoplasma gondii (odds ratio [OR], 1.86; 95% CI, 1.05-3.27; 'P'=.03) and syphilis infection (OR, 3.71; 95% CI, 2.37-5.81; 'P'<.0001). HIV clinical reminders delivered at the time that HIV care is provided were associated with more timely initiation of recommended practices.