TY - JOUR
T1 - Resource utilization across the continuum of HIV care
T2 - An emergency department-based cohort study
AU - Abia, Abia
AU - Rothman, Richard E.
AU - Mohareb, Amir M.
AU - Lim, Grace Li Hsien
AU - Patel, Anuj V.
AU - Bigelow, Benjamin
AU - Klein, Eili Y.
AU - Cole, Gai
AU - Gebo, Kelly A.
AU - Moore, Richard D.
AU - Hsieh, Yu Hsiang
N1 - Funding Information:
Dr. Mohareb is supported by a National Institutes of Health award, trainee appointment to T32AI007433 , from the National Institute of Allergy and Infectious Diseases .
Funding Information:
Dr. Hsieh was supported in part by a National Institutes of Health1 award, K01AI100681 from National Institute of Allergy and Infectious Diseases . Drs. Hsieh and Rothman were supported in part by the Gilead Sciences, Inc. HIV FOCUS program.
Publisher Copyright:
© 2020
PY - 2021/5
Y1 - 2021/5
N2 - Background: The objective of this study was to determine the healthcare resource utilization for people living with HIV (PLWH) presenting to the emergency department (ED) across the HIV Care Continuum. Methods: This prospective study enrolled PLWH presenting to an urban ED between June 2016 and March 2017. Subjects were categorized as being linked to care, retained in care, on antiretroviral therapy (ART), and virally suppressed (<200 copies/ml). Data on ED visit rates, duration of stay, and hospital admission rates were compared to local metrics. Results: Overall, 94.3% of 159 enrollees had been linked to care, 75.5% retained in care, 81.1% on ART, and 62.8% virally suppressed. Compared to the general population of the city and of the ED, participants had a higher ED visit rate (3.0 v. 1.2 visits per person-per year) in the past two years, a higher median duration of ED stay (12.6 v. 7.6 h), and a higher hospital admission rate (36.5% v. 24.9%) during their index ED visit. Viral suppression was negatively associated with admission (OR = 0.35, 95% CI: 0.17, 0.72). Forty-eight (30.2%) participants who had at least eight ED visits in the past two years were more likely to have a diagnosed mental health disorder (79.2% v. 62.2%, p=0.036). Conclusions: Our results showed that PLWH use more ED resources than the general population and a better engagement in HIV care is linked to lesser ED resource utilization for PLWH, indicating the importance of improved HIV care engagement in healthcare utilization management.
AB - Background: The objective of this study was to determine the healthcare resource utilization for people living with HIV (PLWH) presenting to the emergency department (ED) across the HIV Care Continuum. Methods: This prospective study enrolled PLWH presenting to an urban ED between June 2016 and March 2017. Subjects were categorized as being linked to care, retained in care, on antiretroviral therapy (ART), and virally suppressed (<200 copies/ml). Data on ED visit rates, duration of stay, and hospital admission rates were compared to local metrics. Results: Overall, 94.3% of 159 enrollees had been linked to care, 75.5% retained in care, 81.1% on ART, and 62.8% virally suppressed. Compared to the general population of the city and of the ED, participants had a higher ED visit rate (3.0 v. 1.2 visits per person-per year) in the past two years, a higher median duration of ED stay (12.6 v. 7.6 h), and a higher hospital admission rate (36.5% v. 24.9%) during their index ED visit. Viral suppression was negatively associated with admission (OR = 0.35, 95% CI: 0.17, 0.72). Forty-eight (30.2%) participants who had at least eight ED visits in the past two years were more likely to have a diagnosed mental health disorder (79.2% v. 62.2%, p=0.036). Conclusions: Our results showed that PLWH use more ED resources than the general population and a better engagement in HIV care is linked to lesser ED resource utilization for PLWH, indicating the importance of improved HIV care engagement in healthcare utilization management.
KW - Emergency department
KW - HIV
KW - Registry
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U2 - 10.1016/j.ajem.2020.02.037
DO - 10.1016/j.ajem.2020.02.037
M3 - Article
C2 - 32139207
AN - SCOPUS:85080896609
SN - 0735-6757
VL - 43
SP - 164
EP - 169
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -