Objectives Direct-acting antivirals are highly effective in curing hepatitis C virus (HCV) infection but linkage to care remains a barrier to population-wide treatment. Hospitalisation for any cause may be an opportunity to identify candidates for treatment. Here, we present the test characteristics of an electronic medical record (EMR) alert system to identify hospitalised patients with HCV infection.Design We created two alerts based on HCV antibody and RNA values and HCV-specific International Classification of Diseases codes: an ever-alert designed to detect patients with any history of HCV infection (resolved or active) and an active-alert designed to only detect active infections. We performed manual chart review of alerted patients to determine positive predictive value (PPV). We reviewed consecutively hospitalised patients to determine sensitivity.Setting Two affiliated academic tertiary care hospitals in Baltimore, Maryland, USA.Primary and secondary outcome measures: PPV and sensitivity of the alerts for patients with active HCV infection.Participants Hospitalised adults (aged ≥18 years).Results During 12 weeks in 2022 and 2023, the ever-alert fired for 1218 hospitalisations. The ever-alert detected 438 active infections among 1218 alerted hospitalisations (PPV 36.0% (95% CI 33.3% to 38.7%)) compared with 415 active infections among 591 alerts (PPV 70.1% (95% CI 66.4% to 73.8%)) for the active-alert. Both alerts detected 37 of 44 active cases (sensitivity 81.4% (95% CI 70.6% to 92.1%)) among 1115 consecutively hospitalised patients.Discussion The active-alert demonstrated a higher PPV than the ever-alert with a negligible decrease in case detection and similar sensitivity for active infection.Conclusions The active-alert may represent an efficient method of identifying candidates for HCV linkage to care using hospital EMR data. Future directions include deploying the active-alert with a formal linkage to care team.

Objectives Determine if an electronic documentation tool can reduce documentation queries for malnutrition without impacting diagnostic coding. Materials and Methods Malnutrition documentation queries and diagnosis coding proportions were compared between 2 groups of 600 malnourished adults discharged from internal medicine services before and after this electronic malnutrition documentation tool was promoted. Results Documentation queries for malnutrition were observed in 300 (50%) of the preintervention discharges and 112 (19%) of the postintervention discharges (P < .001). A diagnosis code for malnutrition was observed in 99% of both groups. In a logistic regression accounting for clustering by provider, the odds ratio of a query postdeployment vs predeployment was 0.21 (95% CI, 0.16-0.29). In 88 of 112 (79%) of the postintervention discharges queried for malnutrition, the tool was not used as recommended. Conclusions We have demonstrated that introducing and promoting this electronic documentation tool can reduce querying for malnutrition while preserving diagnostic coding.

BACKGROUND:Although 30-day hospital readmission is a widely followed quality measure, there are limited US nationwide data to evaluate its trends among people with HIV (PWH) and the sex disparity over time. We describe the 30-day all-cause unplanned readmission trends among PWH and people without HIV (PWoH) in the United States. SETTING:Adult participants in the 2010-2020 Nationwide Readmissions Database, which weighted represents all US hospitalizations each year. METHODS:We defined index admission and unplanned readmission using the US Centers for Medicare & Medicaid Services criteria. Overall and sex-specific readmission risks were tabulated among the index admissions from adult PWH and PWoH each year in the 2010-2020 Nationwide Readmissions Database. Random effect linear and Poisson regressions were used to estimate risk difference and annual percentage change of the trend. We added a spline in 2015 and additionally stratified the analysis by age and patient's zip code median household income. All analyses were weighted to generate national estimates. RESULTS:Approximately 140,000 index admissions from PWH and 25 million from PWoH were included each year. For PWoH between 2010 and 2020, annual readmission risk was stable at ∼12%. For PWH, readmission risk was stable at ∼22% during 2010-2015 and decreased from 22.0% in 2016 to 20.1% in 2020 (RD= -1.60 [95% CI: -2.24,-0.95]). Nonpregnant female PWH continued to have higher readmission risk than male PWH for all subgroups and all years. Nonpregnant female PWH <40 years had no reduction in readmission risk between 2016 and 2020 (RD= -0.45 [95% CI: -2.43, 1.53]). CONCLUSIONS:There remains strong need for readmission reduction interventions focusing on PWH, especially for young female PWH.

BACKGROUND:Hospitalization causes among persons with HIV (PWH) have shifted to non-AIDS conditions, but the complete disease profile of hospitalized PWH has not been well described. To inform hospitalization and readmission prevention efforts, we examined non-AIDS disease prevalence among PWH hospitalized in 4 US cohorts and 1 Canadian cohort. METHODS:Among PWH with ≥1 hospitalization from 2008 to 2018, we used log-binomial regression with generalized estimating equations to estimate trends in the annual prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease (CKD) stage ≥3, and multimorbidity (≥2 and ≥3 conditions), defined using longitudinal diagnosis, medication, and laboratory data. RESULTS:We examined 6781 hospitalized PWH who were 75% cisgender men, 40% White, and 38% Black. From 2008 to 2018, the proportion of PWH in care who had ≥1 hospitalization decreased from 9.6% to 6.3%. Age- and cohort-adjusted prevalence increased for hyperlipidemia (relative change per year: 3.6% [95% CI: 2.5%-4.7%]), diabetes mellitus (2.8% [1.3%-4.4%]), CKD (3.3% [1.7%-4.9%]), ≥2 conditions (1.3% [0.6%-2.0%]), and ≥3 conditions (3.0% [1.7%-4.3%]), decreased for HCV infection (-2.0% [-3.0%, -0.9%]), and remained stable for HBV infection (1.6% [-1.1%, 4.3%]) and hypertension (0.4% [-0.2%, 1.1%]). CONCLUSIONS:Hospitalized PWH had an increasing burden of several non-AIDS conditions and multimorbidity not accounted for by aging alone. Further work is needed to understand these conditions' role in hospitalization risk among PWH. Our findings reinforce that hospital discharge planning in PWH should include efforts to ensure chronic conditions are adequately managed.

HIV care continuum outcome disparities by health insurance status have been noted among people with HIV (PWH). We therefore examined associations between state Medicaid expansion and HIV outcomes in the United States. Adults (≥18 years) with ≥1 visit in NA-ACCORD clinical cohorts from 2012-2017 contributed person-time annually between first and final visit or death; in each calendar year, clinical retention was ≥2 completed visits > 90 days apart, antiretroviral therapy (ART) receipt was receipt of ≥3 antiretroviral agents, and viral suppression was last measured HIV-1 RNA < 200 copies/mL. CD4 at enrollment was obtained within 6 months of enrollment in cohort. Difference-in-difference (DID) models quantified associations between Medicaid expansion changes (by state of residence) and HIV outcomes. Across 50 states, 87 290 PWH contributed 325 113 person-years of follow-up. Medicaid expansion had a substantial positive effect on CD4 at enrollment (DID = 93.5, 95% CI: 52.9, 134 cells/mm3), a small negative effect on proportions clinically retained (DID = -0.19, 95% CI: -0.037, -0.01), and no effects on ART receipt (DID = 0.001, 95% CI: -0.003, 0.005) or viral suppression (DID = -0.14, 95% CI: -0.34, 0.07). Medicaid expansion had a positive effect on CD4 at entry, suggesting more timely HIV testing and care linkage, but generally null effects on downstream HIV care continuum measures.

Background Thirty-day hospital readmission measures quality of care, but there are limited data among people with HIV (PWH) and people without HIV (PWoH) in the era of universal recommendation for antiretroviral therapy. We descriptively compared 30-day all-cause, unplanned readmission risk between PWH and PWoH. Methods A retrospective cohort study was conducted using the 2019 Nationwide Readmissions Database (2019/01/ 01-2019/12/31), - 2019/12/31), an all-payer database that represents all US hospitalizations. Index (initial) admissions and readmissions were determined using US Centers for Medicare & Medicaid Services definitions. fi nitions. Crude and age- adjusted risk ratios (aRR) comparing the 30-day all-cause, unplanned readmission risk between PWH to PWoH were estimated using random effect logistic regressions and predicted marginal estimates. Survey weights were applied to all analyses. Findings We included 24,338,782 index admissions from 18,240,176 individuals. The median age was 52(IQR = 40-60) - 60) years for PWH and 61(IQR = 38-74) - 74) years for PWoH. The readmission risk was 20.9% for PWH and 12.2% for PWoH (age-adjusted-RR:1.88 [95%CI = 1.84-1.92]). - 1.92]). Stratified fi ed by age and sex, young female (age 18-29 - 29 and 30-39 - 39 years) PWH had a higher readmission risk than young female PWoH (aRR = 3.50 [95%CI = 3.11-3.88] - 3.88] and aRR = 4.00 [95%CI = 3.67-4.32], - 4.32], respectively). While the readmission risk increased with age among PWoH, the readmission risk was persistently high across all age groups among PWH. The readmission risk exceeded 30% for PWH admitted for hypertensive heart disease, heart failure, and chronic kidney disease. Interpretation PWH have a disproportionately higher risk of readmission than PWoH, which is concerning given the aging profile fi le of PWH. More efforts are needed to address readmissions among PWH.

AbstractAmong 8455 people engaged in HIV care in 4 US cities, 4925 (58%) had treponemal testing at care entry. Of the 4925 tested, 3795 (77%) had a nonreactive result and might benefit from the reverse algorithm for a future incident syphilis diagnosis. Furthermore, low-barrier treponemal testing as a first step in the reverse algorithm may increase syphilis screening and decrease time to treatment.

BACKGROUND:Sitting at the bedside may improve patient-clinician communication; however, many clinicians do not regularly sit during inpatient encounters. OBJECTIVE:To determine the impact of adding wall-mounted folding chairs inside patient rooms, beyond any impact from a resident education campaign, on the patient-reported frequency of sitting at the bedside by internal medicine resident physicians. DESIGN, SETTING, AND PARTICIPANTS:Prospective, controlled pre-post trial between 2019 and 2022 (data collection paused 2020-2021 due to COVID-19) at an academic hospital in Baltimore, Maryland. Folding chairs were installed in two of four internal medicine units and educational activities were delivered equally across all units. MAIN OUTCOME AND MEASURES:Patient-reported frequency of sitting at bedside, assessed as means on Likert-type items with 1 being "never" and 5 being "every single time." We also examined the frequency of other patient-reported communication behaviors. RESULTS:Two hundred fifty six and 206 patients enrolled in the pre and post-intervention periods, respectively. The mean frequency of patient-reported sitting by resident physicians increased from 1.8 (SD 1.2) to 2.3 (1.2) on education-only units (absolute difference 0.48 [95% CI: 0.21-0.75]) and from 2.0 (1.3) to 3.2 (1.4) on units receiving chairs (1.16, [0.87-1.45]). Comparing differences between groups using ordered logistic regression adjusting for clustering within residents, units with added chairs had greater increases in sitting (odds ratio 2.05 [1.10-3.82]), spending enough time at the bedside (2.43 [1.32-4.49]), and checking for understanding (3.04 [1.44-6.39]). Improvements in sitting and other behaviors were sustained on both types of units. CONCLUSIONS:Adding wall-mounted folding chairs may help promote effective patient-clinician communication.

Abstract Background Despite the availability of effective therapy, rates of linkage and uptake of hepatitis C virus (HCV) treatment remain suboptimal. People with HCV are hospitalized at a rate 3.7 times that of the general population, presenting an opportunity for linkage to care during inpatient admissions. We designed two novel electronic medical record (EMR) alerts to identify patients with HCV in two hospitals, and report on the alerts’ test-performance characteristics. Methods We developed two distinct EMR alerts and ran them silently on all adult hospitalizations at two academic medical centers in Baltimore, MD. Based on laboratory data, and diagnosis codes (Figure 1); the first alert identified all people ever infected with HCV (ever-alert); and, the second, only people with active HCV viremia (active-alert). We evaluated each alert’s positive predictive value (PPV) by manually reviewing all charts alerted during the study period. We evaluated alert sensitivity by reviewing a sample of consecutive hospital encounters during the same period to determine if they were alerted. Results From 6/29/2022-8/9/2022, the alerts examined 7,519 adult hospital encounters. The ever-alert was triggered for 569 encounters; 563 of 569 were truly ever-infected (PPV 98.9% [95% CI 98.1%, 99.8%]), and 202 of 569 were actively-infected (PPV 35.5% [31.6%, 39.4%]), corresponding to an active infection prevalence of 202/7,519 (2.7%). The active-alert was triggered for 267 encounters; 188 of 267 were actively-infected (PPV 70.4% [65.0%-75.8%]), corresponding to a 2.5% prevalence of active infection. The consecutive chart review examined 1157 patients, 122 (10.5%) of whom were ever-infected, including 44 (3.8%) actively-infected. The ever-alert identified 106/122 (sensitivity 86.9% [80.9%, 92.9%]) and the active-alert identified 37/44 (sensitivity 84.1% [73.3%, 94.9%]) of these respectively (Table 1). Conclusion An alert designed to identify only active infection has a comparable sensitivity (84.1% vs 86.9%) but significantly higher PPV (70.4% vs. 35.5%) for active infection than an alert designed to capture any infection (active or ever). These results support the use of an EMR alert for an HCV outreach program to link patients to care. Disclosures Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant

BACKGROUND Hospital readmission trends for persons with HIV (PWH) in North America in the context of policy changes, improved antiretroviral therapy (ART), and aging are not well-known. We examined readmissions 2005-2018 among adult PWH in NA-ACCORD. METHODS Linear risk regression estimated calendar trends in 30-day readmissions, adjusted for demographics, CD4 count, AIDS history, virologic suppression (<400 copies/mL), and cohort. RESULTS We examined 20,189 hospitalizations among 8,823 PWH (73% cis-men, 38% White, 38% Black). PWH hospitalized in 2018 vs. 2005 had higher median age (54 vs. 44 years), CD4 count (469 vs. 274 cells/μL) and virologic suppression (83% vs. 49%). Unadjusted 30-day readmissions decreased from 20.1% (95% CI 17.9%-22.3%) in 2005 to 16.3% (14.1%-18.5%) in 2018. Absolute annual trends were -0.34% (-0.48%, -0.19%) in unadjusted and -0.19% (-0.35%, -0.02%) in adjusted analyses. By index hospitalization reason, there were significant adjusted decreases only for cardiovascular and psychiatric hospitalizations. Readmission reason was most frequently in the same diagnostic category as the index hospitalization. CONCLUSIONS Readmissions decreased over 2005-2018 but remained higher than the general population's. Significant decreases after adjusting for CD4 count and virologic suppression suggest factors alongside improved ART contributed to lower readmissions. Efforts are needed to further prevent readmissions in PWH.

Introduction: People with HIV, particularly women, have an elevated CVD risk, and a recent trial showed they can benefit from statin initiation even at low/moderate predicted CVD risk. Yet <50% of patients with HIV on statins experience adequate lipid reductions. To inform efforts to reduce CVD risk and gender disparities in this population, we examined statin persistence and adherence by gender in a nationwide sample of privately insured people with HIV. Methods: Among people with HIV ≥18 in MarketScan Commercial Claims who initiated a statin in 2015-2020, we used outpatient pharmacy claims to estimate 1) time to statin interruption (first gap >30 days) and 2) monthly proportion of days covered (PDC) by a statin. PDC analyses censored people if they were off statins ≥6 months. We estimated gender differences in interruption rates using hazard ratios (HR) and in having low adherence (PDC<80%) using risk ratios (RR) adjusted for age, calendar year, US census region, and employment status. Results: There were 7809 statin initiators (17% women; 60% in the South; median age 52 years, IQR 47-57). Two years after statin initiation, 81.0% (95% CI 78.1%-83.8%) of women and 69.8% (68.4%-71.3%) of men had ≥1 statin interruption (adjusted HR women vs. men 1.35 [1.25-1.46]) (Fig. 1A). Monthly PDC decreased in the first 6 months of statin use to 61% for women and 68% for men, then increased to 73% and 80%, respectively, after 2 years (Fig. 1B). Over all months, women more commonly had PDC<80%, with an adjusted RR of 1.27 (1.20-1.34). Conclusions: People with HIV had high statin interruption rates and adherence <80% at most time points, with disparities for women versus men. It is possible that, despite having insurance, women with HIV in this sample are more affected than men with HIV by socioeconomic and other barriers to statin adherence. Gender-specific efforts in people with HIV should address these barriers to promote adherence to CVD preventative pharmacotherapy in this population at high risk.

Background. Hospital readmission trends for persons with human immunodeficiency virus (PWH) in North America in the context of policy changes, improved antiretroviral therapy (ART), and aging are not well-known. We examined readmissions during 2005-2018 among adult PWH in NA-ACCORD. Methods. Linear risk regression estimated calendar trends in 30-day readmissions, adjusted for demographics, CD4 count, AIDS history, virologic suppression (<400 copies/mL), and cohort. Results. We examined 20 189 hospitalizations among 8823 PWH (73% cisgender men, 38% White, 38% Black). PWH hospitalized in 2018 versus 2005 had higher median age (54 vs 44 years), CD4 count (469 vs 274 cells/mu L), and virologic suppression (83% vs 49%). Unadjusted 30-day readmissions decreased from 20.1% (95% confidence interval [CI], 17.9%-22.3%) in 2005 to 16.3% (95% CI, 14.1%-18.5%) in 2018. Absolute annual trends were -0.34% (95% CI, -.48% to -.19%) in unadjusted and -0.19% (95% CI, -.35% to -.02%) in adjusted analyses. By index hospitalization reason, there were significant adjusted decreases only for cardiovascular and psychiatric hospitalizations. Readmission reason was most frequently in the same diagnostic category as the index hospitalization. Conclusions. Readmissions decreased over 2005-2018 but remained higher than the general population's. Significant decreases after adjusting for CD4 count and virologic suppression suggest that factors alongside improved ART contributed to lower readmissions. Efforts are needed to further prevent readmissions in PWH.

This study investigated the challenges and opportunities that built environment professionals in Australia experience when planning, designing, and implementing sustainable housing developments at the neighbourhood scale. It also examined strategies and policy levers employed in case study eco-neighbourhoods from across Australia and Europe to inform future Australian policy and practice.Neighbourhoods are the ‘in-between scales’ between individual buildings and the urban scale and have been described as the ‘building blocks’ of a city. Planning for environments at a neighbourhood scale offers sustainability gains and economies of scale for decentralised systems (such as water and energy) and opportunities for integrated land-use and transport planning, biodiversity planning and social sustainability. Moreover, the neighbourhood scale allows consideration of the importance of communities and social capital for achieving sustainability.The research found there is a need for stricter regulatory requirements on urban sustainability in general, and for policy frameworks and development models to support sustainable housing at a neighbourhood scale specifically. Policy expectations for sustainable neighbourhood developments should be performance-based, rather than prescriptive, and they should be supported by objectives and targets so that achievements can be measured and compared.Many research participants called for mandatory targets, and for binding policies and regulation and sustainable housing and neighbourhood-scale developments to be coordinated across different levels of government and jurisdictions.

Importance:US hospitals report data on many health care quality metrics to government and independent health care rating organizations, but the annual cost to acute care hospitals of measuring and reporting quality metric data, independent of resources spent on quality interventions, is not well known. Objective:To evaluate externally reported inpatient quality metrics for adult patients and estimate the cost of data collection and reporting, independent of quality-improvement efforts. Design, Setting, and Participants:Retrospective time-driven activity-based costing study at the Johns Hopkins Hospital (Baltimore, Maryland) with hospital personnel involved in quality metric reporting processes interviewed between January 1, 2019, and June 30, 2019, about quality reporting activities in the 2018 calendar year. Main Outcomes and Measures:Outcomes included the number of metrics, annual person-hours per metric type, and annual personnel cost per metric type. Results:A total of 162 unique metrics were identified, of which 96 (59.3%) were claims-based, 107 (66.0%) were outcome metrics, and 101 (62.3%) were related to patient safety. Preparing and reporting data for these metrics required an estimated 108 478 person-hours, with an estimated personnel cost of $5 038 218.28 (2022 USD) plus an additional $602 730.66 in vendor fees. Claims-based (96 metrics; $37 553.58 per metric per year) and chart-abstracted (26 metrics; $33 871.30 per metric per year) metrics used the most resources per metric, while electronic metrics consumed far less (4 metrics; $1901.58 per metric per year). Conclusions and Relevance:Significant resources are expended exclusively for quality reporting, and some methods of quality assessment are far more expensive than others. Claims-based metrics were unexpectedly found to be the most resource intensive of all metric types. Policy makers should consider reducing the number of metrics and shifting to electronic metrics, when possible, to optimize resources spent in the overall pursuit of higher quality.

Multiple market failures have historically delivered housing that is environmentally and economically sub-optimal. Minimum energy standards are a popular policy tool for lowering energy use and anthropogenic carbon emissions in the built environment, but evidence shows they fail to drive performance beyond that minimum. Mandating the disclosure of energy performance on sale or lease of property has been introduced in some jurisdictions to transform the building stock and encourage energy and carbon saving improvements. These policy instruments address different market failures and have the potential to act as complementary regulation, but to date there has been little evidence that the combination may deliver greater benefits than each individual policy measure. The analysis of 342,674 housing energy assessments in Australia from May 2016–June 2021 highlights the impact of complementary vs. single policy instruments. We find that the building regulatory process alone delivers certainty regarding minimum performance, but when matched with disclosure regulation, the market is pulled slightly toward higher performance outcomes than for where building regulations alone are used. While only a small improvement in performance, the data supports the power of complementary regulation for long-life housing assets, similar to the benefits found for shorter-life assets such as household appliances; in essence creating both a carrot and a stick for consumers and the wider market. The data from Australia presented in this paper suggests that the use of complementary regulation may deliver improved environmental and economic outcomes and could help jurisdictions governing a transition to more sustainable housing as part of the wider transition to sustainable cities.

Sitting at the bedside may strengthen physician–patient communication and improve patient experience. Yet despite the potential benefits of sitting, hospital physicians, including resident physicians, may not regularly sit down while speaking with patients. To examine the frequency of sitting by internal medicine residents (including first post-graduate year [PGY-1] and supervising [PGY-2/3] residents) during inpatient encounters and to assess the association between patient-reported sitting at the bedside and patients’ perceptions of other physician communication behaviors. We also assessed residents’ attitudes towards sitting. In-person survey of patients and email survey of internal medicine residents between August 2019 and January 2020. Patients admitted to general medicine teaching services and internal medicine residents at The Johns Hopkins Hospital. Patient-reported frequency of sitting at the bedside, patients’ perceptions of other communication behaviors (e.g., checking for understanding); residents’ attitudes regarding sitting. Of 334 eligible patients, 256 (76%) completed a survey. Among these 256 respondents, 198 (77%) and 166 (65%) reported recognizing the PGY-1 and PGY-2/3 on their care team, respectively, for a total of 364 completed surveys. On most surveys (203/364, 56%), patients responded that residents “never” sat. Frequent sitting at the bedside (“every single time” or “most of the time,” together 48/364, 13%) was correlated with other positive behaviors, including spending enough time at the bedside, checking for understanding, and not seeming to be in a rush (p < 0.01 for all). Of 151 residents, 77 (51%) completed the resident survey; 28 of the 77 (36%) reported sitting frequently. The most commonly cited barrier to sitting was that chairs were not available (38 respondents, 49%). Patients perceived that residents sit infrequently. However, sitting was associated with other positive communication behaviors; this is compatible with the hypothesis that promoting sitting could improve overall patient perceptions of provider communication.

OBJECTIVES:Electronic medical record (EMR) tools can identify specific populations among hospitalised patients, allowing targeted interventions to improve care quality and safety. We created an EMR alert using readily available data elements to identify hospitalised people with HIV (PWH) to facilitate a quality improvement study intended to address two quality/safety concerns (connecting hospitalised PWH to outpatient HIV care and reducing medication errors). Here, we describe the design and implementation of the alert and analyse its accuracy of identifying PWH.METHODS:The EMR alert was designed to trigger for at least one of four criteria: (1) an HIV ICD-10-CM code in a problem list, (2) HIV antiretroviral medication(s) on medication lists, (3) an HIV-1 RNA assay ordered or (4) a positive HIV-antibody result. We used manual chart reviews and an EMR database search to determine the sensitivity and positive predictive value (PPV) of the overall alert and its individual criteria.RESULTS:Over a 24-month period, the alert functioned as intended, notifying an intervention team and a data abstraction team about admissions of PWH. Manual review of 1634 hospitalisations identified 18 PWH hospitalisations, all captured by the alert (sensitivity 100%, 95% CI 82.4% to 100.0%). Over the 24 months, the alert triggered for 1191 hospitalisations. Of these, 1004 were PWH hospitalisations, PPV=84.3% (95% CI 82.2% to 86.4%). Using fewer criteria (eg, using only ICD-10-CM codes) identified fewer PWH but increased PPV.CONCLUSION:An EMR alert effectively identified hospitalised PWH for a quality improvement intervention. Similar alerts might be adapted as tools to facilitate interventions for other chronic diseases.

Background The incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is increasing in the United States; however, there are limited data on anatomic site-specific GC/CT among people with HIV (PWH). Methods We reviewed records of all PWH in care between January 1, 2014, and November 16, 2018, at 4 sites in the CFAR Network of Integrated Clinical Systems Cohort (CNICS; n = 8455). We calculated anatomic site-specific GC/CT testing and incidence rates and used Cox proportional hazards models modified for recurrent events to examine sociodemographic and clinical predictors of GC/CT testing and incidence at urogenital, rectal, and pharyngeal sites. We also calculated site-specific number needed to test (NNT) to detect a positive GC/CT test. Results Of 8455 PWH, 2460 (29.1%) had at least yearly GC/CT testing at any anatomic site. The rates of urogenital, rectal, and pharyngeal GC were 1.7 (95% CI, 1.6-1.9), 3.2 (95% CI, 3.0-3.5), and 2.7 (95% CI, 2.5-2.9) infections per 100 person-years, respectively. The rates of urogenital, rectal, and pharyngeal CT were 1.9 (95% CI, 1.7-2.1), 4.3 (95% CI, 4.0-4.5), and 0.9 (95% CI, 0.8-1.0) infections per 100 person-years, respectively. PWH 16-39 years old experienced greater GC/CT rates at all anatomic sites, while men who have sex with men experienced greater rates of extragenital infections. NNTs for urogenital, rectal, and pharyngeal GC/CT were 20 (95% CI, 19-21), 5 (95% CI, 5-5), and 9 (95% CI, 8-9), respectively. Conclusions Many PWH are not tested annually for GC/CT, and rates of GC/CT infection, particularly rates of extragenital infections, are high. We identified groups of PWH who may benefit from increased site-specific GC/CT testing.