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HIV Rapid Testing in a VA Emergency Department Setting: Cost Analysis at 5 Years
1Veterans Affairs (VA) Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP) and Center for the Study of Healthcare Provider Behavior, Los Angeles, CA, USA; Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Los Angeles, VA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Objectives:
To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department (ED) registered nurses administered HIV oral rapid tests to patients.
Methods:
A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing. Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years. Comprehensive cost analyses were conducted to evaluate the financial impact of this implementation.
Results:
At 5 years, a total of 2,620 tests were conducted with a quarterly mean of 131 ± 81. Despite quarterly variability in testing rates, regression analysis revealed an average increase of 3.58 tests per quarter. Over the course of this implementation, Veterans Health Administration policy transitioned from written to verbal consent for HIV testing, serving to reduce the time and cost(s) associated with the testing process.
Conclusions:
Our data indicated salient health outcome benefits for patients with respect to the potential for earlier detection, and associated long-run cost savings.
