TY - JOUR
T1 - Graphical analysis of guideline adherence to detect systemwide anomalies in HIV diagnostic testing
AU - Hauser, Ronald George
AU - Bhargava, Ankur
AU - Brandt, Cynthia A.
AU - Chartier, Maggie
AU - Maier, Marissa M.
N1 - Publisher Copyright:
© 2022 Public Library of Science. All rights reserved.
PY - 2022/7
Y1 - 2022/7
N2 - Background Analyses of electronic medical databases often compare clinical practice to guideline recommendations. These analyses have a limited ability to simultaneously evaluate many interconnected medical decisions. We aimed to overcome this limitation with an alternative method and apply it to the diagnostic workup of HIV, where misuse can contribute to HIV transmission, delay care, and incur unnecessary costs. Methods We used graph theory to assess patterns of HIV diagnostic testing in a national healthcare system. We modeled the HIV diagnostic testing guidelines as a directed graph. Each node in the graph represented a test, and the edges pointed from one test to the next in chronological order. We then graphed each patient's HIV testing. This set of patient-level graphs was aggregated into a single graph. Finally, we compared the two graphs, the first representing the recommended approach to HIV diagnostic testing and the second representing the observed patterns of HIV testing, to assess for clinical practice deviations. Results The HIV diagnostic testing of 1.643 million patients provided 8.790 million HIV diagnostic test results for analysis. Significant deviations from recommended practice were found including the use of HIV resistance tests (n = 3,007) and HIV nucleic acid tests (n = 16,567) instead of the recommended HIV screen. Conclusions We developed a method that modeled a complex medical scenario as a directed graph. When applied to HIV diagnostic testing, we identified deviations in clinical practice from guideline recommendations. The model enabled the identification of intervention targets and prompted systemwide policy changes to enhance HIV detection.
AB - Background Analyses of electronic medical databases often compare clinical practice to guideline recommendations. These analyses have a limited ability to simultaneously evaluate many interconnected medical decisions. We aimed to overcome this limitation with an alternative method and apply it to the diagnostic workup of HIV, where misuse can contribute to HIV transmission, delay care, and incur unnecessary costs. Methods We used graph theory to assess patterns of HIV diagnostic testing in a national healthcare system. We modeled the HIV diagnostic testing guidelines as a directed graph. Each node in the graph represented a test, and the edges pointed from one test to the next in chronological order. We then graphed each patient's HIV testing. This set of patient-level graphs was aggregated into a single graph. Finally, we compared the two graphs, the first representing the recommended approach to HIV diagnostic testing and the second representing the observed patterns of HIV testing, to assess for clinical practice deviations. Results The HIV diagnostic testing of 1.643 million patients provided 8.790 million HIV diagnostic test results for analysis. Significant deviations from recommended practice were found including the use of HIV resistance tests (n = 3,007) and HIV nucleic acid tests (n = 16,567) instead of the recommended HIV screen. Conclusions We developed a method that modeled a complex medical scenario as a directed graph. When applied to HIV diagnostic testing, we identified deviations in clinical practice from guideline recommendations. The model enabled the identification of intervention targets and prompted systemwide policy changes to enhance HIV detection.
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U2 - 10.1371/journal.pone.0270394
DO - 10.1371/journal.pone.0270394
M3 - Article
C2 - 35776743
AN - SCOPUS:85133388216
SN - 1932-6203
VL - 17
JO - PloS one
JF - PloS one
IS - 7 July
M1 - e0270394
ER -