NURS 503 Week 6 Population Health Intervention Project Outline Example

Population Health Intervention Project Outline: Routine Opt-Out HIV Screening With Nurse-Led Linkage in a Virginia Emergency Department

Health Indicator and Problem

• Indicator: Healthy People 2030 objective HIV-02, the share of people with HIV, age 13 and up, who know they have it; 85.8% in 2017 and 87.2% in 2022 against a target of 95.0% (Office of Disease Prevention and Health Promotion [ODPHP], n.d.).
• Local problem: the emergency department of a 260-bed hospital in Virginia sees about 52,000 visits a year, and HIV tests are ordered only on clinical suspicion; about 9% of eligible patients are offered a test.
• Gap: routine screening is recommended for everyone aged 15 to 65 (U.S. Preventive Services Task Force, 2019), and many patients have no other regular source of care.

Target Population and Setting

• Population: emergency department patients aged 15 to 65 who are not known to have HIV, are not critically ill and can consent; about 30,000 eligible visits a year.
• Setting: adult emergency department and its fast-track area, open 24 hours.
• Priority subgroup: patients aged 15 to 29, who have the lowest awareness nationally.

Intervention

The intervention makes an HIV test part of routine laboratory work for eligible patients unless they decline, and pairs it with a nurse navigator who owns every reactive result from notification to the first HIV care visit. Screening and linkage are planned as one program so that a rise in tests cannot outpace the capacity to follow them.

• Triage nurse script offering the test as routine for every eligible patient, with a clear option to decline.
• Order set default: HIV antigen and antibody test added to blood work for eligible patients.
• Results routing: every reactive result sent to a navigator queue checked twice daily.
• Navigator follow-up: patient contact within 72 hours, confirmatory testing and an appointment with the regional HIV clinic within 30 days.

Objectives

• 1. By month six, at least 60% of eligible patients will be offered an HIV test, up from about 9% at baseline.
• 2. By month six, at least 70% of patients offered a test will accept it.
• 3. Throughout the project, at least 90% of patients with a confirmed new diagnosis will attend an HIV care appointment within 30 days.

Rationale and Evidence

• Defaults: in a randomized trial of 8,715 emergency patients, opt-out offers raised test acceptance by 23.9 percentage points over opt-in offers (Montoy et al., 2018).
• Recommendations: CDC has recommended routine opt-out screening in health care settings since 2006 (Branson et al., 2006).
• Feasibility: a multicenter trial found routine emergency department screening added about 1.4 minutes to average wait time (Jones et al., 2025).
• Framework: behavioral economics and choice architecture, with population health management as the organizing approach (Nash et al., 2016).

Anticipated Barriers and Responses

• Staff concern about workload: the test is added to blood already being drawn, and the order set does the work, so the added nursing task is one scripted sentence.
• Fear of delivering positive results: disclosure is handled by the navigator or a trained provider, not by the triage nurse.
• Patients without phones or stable addresses: the navigator collects two contact methods at registration and works with health department staff when patients cannot be reached.
• Stigma: the script frames the test as something offered to everyone, and staff training includes language that avoids judgment.

Stakeholders

• Emergency nurses, physicians and advanced practice providers; laboratory; information technology; hospital quality department.
• Regional HIV clinic and local health department disease intervention specialists.
• Patients and a community advisory group that includes people living with HIV.

Resources

• One full-time nurse navigator; laboratory test costs; information technology time to build the order set and queue; staff training of about one hour per nurse.
• Possible funding: state health department HIV testing funds and hospital community benefit budget.

Timeline

• Month 1: approvals, order set build, navigator hiring, staff training.
• Month 2: launch in the main emergency department.
• Months 3 to 6: weekly data review, monthly feedback to staff, expansion to fast track in month 3.

Evaluation Plan

• Framework: RE-AIM, assessing reach, effectiveness, adoption, implementation and maintenance (Glasgow et al., 1999).
• Measures: proportion offered, proportion accepting, new diagnoses, time to contact, linkage within 30 days, effect on wait times.
• Review: monthly run charts shared with staff and a six-month report to hospital leadership.
• Balancing measures: median wait time and the share of patients leaving before treatment is complete, to confirm screening does not slow care.

Ethical and Faith Considerations

Patients will be told that testing is routine and that they may decline, and results will be kept confidential. The program reflects the command to "do justice, and to love kindness, and to walk humbly with your God" (English Standard Version Bible, 2001/2016, Micah 6:8): offering the test to everyone, not only those who look at risk, is a matter of fairness and kindness.

References

Branson, B. M., Handsfield, H. H., Lampe, M. A., Janssen, R. S., Taylor, A. W., Lyss, S. B., & Clark, J. E. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recommendations and Reports, 55(RR-14), 1-17.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

Jones, A. T., Haukoos, J., Hopkins, E., Lyons, M. S., Rothman, R. E., White, D. A. E., Hsieh, Y. H., Joseph, K. M., Murray, E., & Rowan, S. E. (2025). Effect of routine opt-out HIV screening on emergency department operational metrics: Results from the pragmatic randomized HIV TESTED trial. Annals of Emergency Medicine, 86(3), 240-251. https://doi.org/10.1016/j.annemergmed.2025.04.011

Montoy, J. C. C., Dow, W. H., & Kaplan, B. C. (2018). Cash incentives versus defaults for HIV testing: A randomized clinical trial. PLOS ONE, 13(7), Article e0199833. https://doi.org/10.1371/journal.pone.0199833

Nash, D. B., Fabius, R. J., Skoufalos, A., Clarke, J. L., & Horowitz, M. R. (2016). Population health: Creating a culture of wellness (2nd ed.). Jones & Bartlett Learning.

Office of Disease Prevention and Health Promotion. (n.d.). Increase knowledge of HIV status: HIV-02. Healthy People 2030. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/sexually-transmitted-infections/increase-knowledge-hiv-status-hiv-02

U.S. Preventive Services Task Force. (2019). Screening for HIV infection: US Preventive Services Task Force recommendation statement. JAMA, 321(23), 2326-2336. https://doi.org/10.1001/jama.2019.6587