Increasing HIV Testing Rates in Peach County, Georgia

Summary

Impact Statement:

This health department was able to achieve a 51% improvement in HIV testing rates, which can result in identifying more people with HIV and better, more immediate treatment. In order to reduce redundancy, the QI project team eliminated one of the demographic forms that had been required, saving staff and client time during the clinic visit. Due to the high success rate of this implementation, the leadership has removed the demographic form from the HIV testing process in 13 other counties within that district.

Summary:

For the 13 counties within the North Central Health District in Georgia, HIV Testing is a mandatory part of a routine and annual family planning visit unless the patient opts out. It is also offered as a non-mandatory option under the STD program. Thus, the HIV Program Coordinator set the expected rate of HIV testing at 80% within North Central Health District for the age group of 15-44.

During July 1 through July 31, 2014, to avoid spending time on the collection of redundant data, the Peach County Health Department tested the removal of the confidential HIV test record form. This is a consent form with demographic information that is unnecessary to collect because this information is already saved in the district's Mitchell and McCormick (M&M) database. Removal of this form was approved by program and district leadership before implementation.

Removing the demographic form increased efficiency in Peach County Health Department. Specifically, this created less work for the nursing staff and reduced the total amount of time required for a patient visit by a few minutes. These few extra minutes make a huge difference in the overall picture. Because of the high success rate of this implementation, staff have removed the demographic form from the HIV testing process in all 13 counties within the NCHD.

Organization that conducted the QI initiative:

NCHD 5-2

Citation:

Roberts, G. Public Health Quality Improvement Exchange. Increasing HIV Testing Rates in Peach County, Georgia. Wed, 10/11/2017 - 11:27. Available at http://www.phqix.org/content/increasing-hiv-testing-rates-peach-county-georgia. Accessed October 10, 2024.

Background and Aim

Aim statement:

After noticing that the HIV testing rates were significantly lower than the expected 80%, staff created a quality improvement (QI) initiative to increase testing rates, specifically in Peach County, Georgia. A simple change was implemented during July 2014, which focused on removing one of the consent forms used for the HIV testing process. By comparing the number of HIV tests done and the eligible patient visits, an HIV testing percentage was calculated. This change affected the Peach County Health Department staff involved in the HIV testing process, district staff who are in charge of allocating resources to those counties with a higher need for HIV testing, and the patients served.

Need For The QI Initiative:

The QI Council examined HIV testing rates from February 2014 and chose Peach County for the pilot project based on the low number of tests being performed. Regarding baseline data, out of 39 eligible visits, 10 HIV tests were done, equaling a 26% testing rate. The QI Council also did a process map of the HIV testing process to determine which steps were involved. Based on these steps, the QI Council chose 5–8 team members to be a part of the QI project team, including three NCHD employees and four Peach County (front-line) staff members. The QI coordinator facilitated this pilot project because it was the first QI project officially conducted since the NCHD QI plan had been adopted.

Area for Improvement:

HIV cases are at an alarming number in Georgia as a whole. Georgia ranked sixth highest in the nation for total number of adults and adolescents living with HIV infection in 2010 and ranked the fourth highest for new diagnoses in 2011. In 2012, in Georgia, persons testing late for HIV infection accounted for 57% of new AIDS diagnoses. Late testing results in missed opportunities for prevention and treatment of HIV infection and emphasizes the need for earlier testing, linkage, and retention in care for persons living with HIV. The NCHD is the center of Georgia and consists of one of the highest rates of HIV in the state. From 2006 to 2010, only 47% of adults in the NCHD reported ever being tested for HIV, which was a 12% decrease from 2000 to 2004 (55%). The NCHD is home to the Hope Center, a specialized HIV treatment facility. The HIV program provides free HIV testing that uses a mouth swab and takes only 20 minutes to get results. This test is called OraQuick, and it is also a mandatory part of a routine and annual visit at Peach County Health Department. Therefore, because the barriers of cost, time, and a needle blood draw are reduced, testing rates should be near 80%.

Root Cause:

The root causes were as follows: • Paperwork/consent forms are very time consuming. • The M&M database does not give nurses credit for offering an HIV test if the patient declines it. • M&M workflow screens are slow, and it takes a lot of time to enter the information for an HIV test.

Planning and Execution Details

QI Implementation:

The process map was used to figure out which parts of the HIV testing process were slowing the process down. The root cause analysis helped with figuring out the areas of improvement that staff could focus on. Out of the three areas for improvement that were identified, staff could implement only the removal of the demographic/consent form. The other two improvements were related to the M&M database that the nurses use to enter information, and this program was receiving an update on August 1. Therefore, staff could not make changes to the program before the update, and the update was happening after the implementation period (July 1–31). The initiative affected patients, county staff, and district staff. The patients became knowledgeable about their HIV status. The county staff were able to provide services to improve community health. The district staff were able to allocate resources to the counties that have a higher need for HIV testing.

Focus activities

Screening for diseases and conditions:

HIV/AIDS

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Five whys

Process maps

Root cause analysis

QI Tool Documentation:

HIV testing process map completed by the QI project team

HIV testing root cause analysis was done by asking the 5-Whys. The QI project team performed the analysis.

Initiative Dates:

6/3/14 to 8/11/14

Initiative Duration:

Less than 6 months

Methods of evaluation:

Staff gathered productivity data from the M&M database. This database is used to track all clinical nursing encounters. The data consisted of how many visits were eligible to receive an HIV test and how many HIV tests were actually given. Baseline data were collected for February 2014, and the final data were collected for July 2014. When comparing these data, testing rates had increased by 51%. Data collection was implemented in all of the 13 counties within the NCHD in August 2014; thus, staff will follow up and collect these same data for December 2014 to measure the wide-range impact. Data were also gathered from the Peach County Health Department front-line staff, in person and over the phone. Peach County Health Department staff reflected on their observations, and these were noted in the project charter.

Other Information:

This is the FIRST QI project since the adoption of the QI plan in May 2014. The staff are so proud! The project charter is attached. This was a guide that was used to help work through the QI project. The charter is based on the Plan, Do, Check, Act (PDCA) cycle. The project storyboard that is based on the charter and PDCA cycle is also attached. The storyboard is being displayed at the Peach County Health Department as a handout and is being sent to community partners. The confidential HIV test record form that was removed from the HIV testing process is attached as well.

Supplemental Materials:

Sample of materials produced

Storyboard

Supplemental Files:

Attachment	Size
QI Storyboard (HIV Testing).pub	4.39 MB
QI Project Charter (HIV Testing).docx	3.12 MB
HIV Testing Demographic Form.pdf	32.42 KB

Results

Measurable QI Outcomes:

Overall, HIV testing rates increased from the baseline data collected in February 2014 (26%) to 77% testing in July 2014, resulting in an increase of 51%. NCHD staff realize that this is a huge increase from baseline data. This may have been affected because of the QI project's focus on this specific process at this specific health department. Peach County Health Department staff may have been more aware and focused on improving this process. NCHD staff will follow up in a few months to determine whether the rates are still as high.

Other QI Outcomes:

Removing the demographic form increased efficiency in Peach County Health Department. Specifically, it created less work for the nursing staff and reduced the total amount of time required for a patient visit by a few minutes. These few extra minutes make a huge difference in the overall picture. For example, the nurses saved 5 minutes per visit by removing this form, thus saving 3 hours during July. Even if these 3 hours were used to relax, removal of the form has positively affected county staff and has reduced patient wait/visit times. Also, because of the success of this QI project, the NCHD has received a lot more QI project suggestions from staff. This project helped increase interest in QI because it was simple and had a huge positive impact. This is essential for creating a culture of quality.

Lessons Learned, Observations and Insights:

Unexpected observations were as follows: Although Peach County has a large college student population and high sexually transmitted disease (STD) rates within this population, testing can be done at other locations, which lowers the testing numbers for the health department. HIV testing is also being done at the Phoenix Center (next door to the Peach County Health Department) Monday through Friday and at the Fort Valley State University campus on Wednesdays. Both of these services are free and more convenient for college students. Testing is more convenient at the Phoenix Center because the students do not have to deal with any other medical checkups or paperwork like they do at the health department. It is more convenient for students to be on campus because they do not have to travel to the health department. The health department was not selected for the Title X grant for the period beginning on July 1, 2014. This announcement came mid-July during the implementation period. Staff are not sure exactly how this will affect the QI project, but some of the paperwork required for HIV testing was required for Title X funding. Therefore, this paperwork will no longer be required, which will automatically reduce the visit time and paperwork. Constraints were as follows: The M&M database is receiving an update on August 1 that may change the HIV workflow. This is one reason why staff did not implement a change to the workflows that they originally planned on doing. Staff are waiting to see the new workflows to determine whether a change is still needed.

Future Plans:

The NCHD has adopted this QI initiative. Because of the high success rate of this implementation, staff have removed the demographic form from the HIV testing process in all 13 counties within the NCHD. Data will be continually collected quarterly to monitor HIV testing rates. Staff will communicate these results by taking the following actions: • The QI coordinator will communicate results to the QI Council in September 2014. • An email has been sent to the other 12 counties within the district to notify them of the implementation. • A storyboard has been created from the project charter to be displayed at the NCHD and Peach County Health Department lobbies and as a handout for patients and community partners. • A poster has also been made to be displayed in the Peach County Health Department lobby and the NCHD lobby in September 2014.

Increasing HIV Testing Rates in Peach County, Georgia

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

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QI Spotlight

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Increasing HIV Testing Rates in Peach County, Georgia

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

QI Spotlight