6/26 Update

So it appear as though things are starting to pick up around here!



This week I've been working more on the WHIE project.

What is the WHIE? Excellent question!!

The Wisconsin Health Information Exchange project is an electronic health program that enables Milwaukee area EDs to share health information on ER patients.

We are currently working with the WHIE directors to get ARCW onto the program so that we may access and share patient information with the ERs in the Milwaukee area. Any time one of our patients visits an ER they should make a visit to the ARCW clinic within 72 hours. Unfortunately, we have difficulty accurately following ER visits and thus have very few follow up appointments with these patients.

In order to quantify the importance of capturing more ER visits by ARCW patients, we are looking at all the documented ER visits in the ARCW system for a certain time period. Once we have access to the WHIE system, we can find out exactly how many ER visits were missed by the current ARCW system for documenting ER visits which usually rely on phone calls made by the patient or ER to our staff.

So that means I get to look through months of ARCW patient information trying to find evidence of ER visits!

I've also joined up with another study which is utilizing a prediction model for virologic failure created by MGH staff. We are adapting their model to fit our patient population and medical record system at ARCW. Ideally, we will be able to reliably predict which patients are at risk for virologic failure and act accordingly.

So that's my brief update, more to come!
-Chad

First Impressions

So I've finally started my summer research project as of last week!

While I haven't made significant progress in changing society saving lives or fixing our health care system, I have spent a lot of time reading research literature. I spent the majority of my time at my little desk and ARCW extensively reviewing the literature on HIV and ERs. It may not sound exciting, but I have learned a lot of interesting things about HIV testing in ERs and health care utilization by HIV patients. Don't worry, I won't bore you with the details. :)

The really interesting experiences have come from my shadowing experiences with Dr. Fangman. Last week Dr. Fangman allowed me to shadow him during this clinic hours here at ARCW. The patients we saw were truly astounding! Not because they had some incredible disease I've never heard of. Instead, the social histories and lives that these HIV patients face everyday is so radically different from my own experiences that it has drastically changed my perspective of these patients. So many of these people have faced violence, drugs, alcohol and death that it amazes me that they even show up for their routine HIV visits. Most of the patients can't drive or don't have cars, so they have to rely on public transportation or the good will of others to get to work, a grocery store or to an HIV clinic like ARCW. It is quickly becoming apparent that there exists several barriers to proper care for these individuals.

So what happens when they stop showing up for routine HIV care?

When an HIV patient stops adhering to their medications, their health will deteriorate rather quickly resulting in increased visits to the ER with AIDS related illnesses or opportunistic infections. Currently, ERs rarely screen their patients for HIV even when a patient presents with AIDS related symptoms or high risk factors like STD's. Even fewer refer HIV patients to aftercare clinics like ARCW. We hope to develop a system in which we can monitor ARCW patients who present to an ER in hope that we can reconnect with these individuals to improve their quality of life. We also are aiming to increase HIV testing in ERs to catch more HIV patients before they progress to AIDS.

There's a lot of work ahead of us with this project. There's only so much I can aim to achieve this summer with such goals. It's ambitious I know, but that's why I wanted to be a part of it.

-Chad

Introductions

The last 7 days kicked off my first week in the WMS Fellowship working with Dr. Fangman!

For those who aren't familiar with my project this summer, I'll give you a quick introduction. Currently, there are approximately 1 million people in the US living with HIV/AIDS and 40,000 new diagnosis anually. In order to reduce the incidence of HIV infection in Milwaukee and to improve the quality of life for HIV patients, Dr. Fangman and I are initiating a program to help us identify, screen and increase the follow up care of HIV patients presenting in Emergency Departments.

Why focus on ER's?

A lot of our patients are either difficult to reach or prefer to hide their HIV status due to the stigma surrounding the disease. Therefore, the ER gives us a unique opportunity to reconnect with these individuals and link them to aftercare programs like the AIDS Resource Center of Wisconsin where I am currently working the Dr. Fangman who is the medical director of this location. Furthermore, the ER provides us with another opportunity to screen patients for HIV based on the presence of certain risk factors.

So this all sounds great, but how realistic are these goals? ERs are already overcrowded, overburdened, and overstressed. To get the ER staff to test for HIV and refer them to aftercare is asking them to increase their work load. So right now we are planning on developing a survey to assess what barriers are currently preventing ERs from screening HIV patients.
So that's the plan, stay tuned for updates!

-Chad