Linkage to HIV Outpatient Care Following an Inpatient Stay

BACKGROUND: Immediate linkage to outpatient HIV follow-up care after hospitalization is a crucial opportunity to review treatment plan and coordinate necessary and additional services. The purpose of this review is to evaluate potential gaps in transition from inpatient to outpatient care services in persons with HIV. Data from multiple electronic medical records and billing systems were used to assess the rate of follow-up care at HIV outpatient facilities within the Mount Sinai Health System (MSHS), among patients hospitalized in four of the largest hospitals within MSHS. METHODS: ICD-10 codes were utilized to capture all hospitalized patients in 2016 with a primary or secondary diagnosis of HIV and their discharge date, across various electronic systems used by MSHS hospitals. Additional visit data was pulled from the EMR used by the five HIV outpatient facilities in order to determine the linkage to care rate. Linkage to HIV care was defined as the proportion of patients who attended an appointment at one of five HIV outpatient clinics within MSHS, within 90 days of discharge. RESULTS: A total of 3,992 inpatient discharges were associated with the diagnosis of HIV at the Mount Sinai Health System in 2016. Among these, 2,760 (69%) were male and 1,970 (49%) were African Americans while 56% were in the range of 50–69 years. The average length of stay was 6.6 days (SE±0.6). Out of these discharges, 1020 (25%) were scheduled to be seen at the system’s HIV outpatient care facilities within the 90 day interval. Subsequently, 275 patients (27%) have kept their appointments. CONCLUSION: The data suggests that a smaller proportion of the inpatient discharges is linked to care within the system in addition to low appointment compliance rate. Further efforts to optimize early linkage to care and retention may help to affect patient outcomes. Interventions focusing on chronic disease management may assist to further improve these rates. At the systems level, enhanced and increased discharge planning and coordination is required between inpatient units and outpatient clinics in addition to greater outreach by outpatient clinics immediately upon discharge. DISCLOSURES: All authors: No reported disclosures.