153 - Effectiveness of clinical decision support in improving HIV screening in pediatric primary care

Publication Number: 153.4722

Sarah Wood, Icahn School of Medicine at Mount Sinai, Philadelphia, PA, United States; Gabrielle DiFiore, Children's Hospital of Philadephia, Philadelphia, PA, United States; Mary Kate Kelly, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Stephanie Mayne, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Gregory Lawton, Childrens Hospital of Philadelphia, chesterbrook, PA, United States; Anthony Luberti, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Angela M. Rapposelli, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Haley Belardo, Childrens Hospital of Philadelphia, Ann Arbor, MI, United States; Robert Gross, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Alexander G. Fiks, Children's Hospital of Philadelphia, Merion Station, PA, United States; Brian Jenssen, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Clinical decision support (CDS) systems are a promising strategy to improve low HIV screening in pediatric settings .

Objective: We aimed to assess the effectiveness of a CDS system to improve HIV screening at well-adolescent visits.

Design/Methods: In this quasi-experimental pragmatic study, we developed and launched an electronic health record (EHR)-based CDS system across a 31-clinic, northeastern U.S, pediatric primary care network. The system included three components at annual well visits: 1) EHR order sets with non-defaulted HIV test orders and universal HIV screening recommendations for patients 13+ years, 2) the Adolescent Health Questionnaire (AHQ), an electronic screener assessing sexual activity and other domains completed by adolescents on visit arrival, and 3) an automated EHR alert in the visit note of sexually active youth reminding clinicians to screen for HIV. Interrupted time series (ITS) analyses assessed differences in HIV screening rates pre- and post-CDS (12/2022-6/2023 vs 6/2023-12/2023) at well visits. Logistic regression included a binary indicator of HIV test completion (primary outcome), a fixed effect accounting for non-independence of observations within clinics, time in months, a binary indicator for intervention period, and a time x intervention period interaction term. To a priori explore subgroup differences in effectiveness, separate ITS models also included interaction terms for patient race, ethnicity, sex assigned at birth, gender identity, sexual orientation, and insurance.

Results: Of 60,592 adolescents aged 13-19 years-old (n=26,267 pre-CDS; n=34,325 post-CDS), 2.2% received HIV testing. Patients were 24.7% Black, 8.7% Latine, 49.5% female sex, 9.0% identified as LGBTQ, median age was 15 (IQR = 3), and 15.1% reported sexual activity. Among sexually active patients, 11.1% received HIV testing. In ITS analyses, there were no differences in HIV test completion rates between the pre- and post-CDS periods for all adolescents (OR 1.03, 95% CI: 0.87, 1.09). Similarly, there were no differences in HIV screening rates for sexually active youth (OR 1.11, 95% CI: 0.79, 1.03; Figure 1). In subgroup analyses, there were no significant differences in HIV test completion within any patient subgroups.

Conclusion(s): In this pragmatic study of a large regional pediatric healthcare system, we found no significant effect of a CDS system on HIV screening. Our findings suggest that CDS primarily targeting HIV screening knowledge and situational awareness may not be sufficient to improve HIV testing. Future CDS interventions should target additional systemic barriers to testing.

Figure 1: Interrupted time series displaying HIV test completion rates pre- and post-clinical decision support implementation in sexually active youth