Finding Medical Homes for STIs in New York State

Background:  Systematic methods for monitoring the quality of STI diagnostic and treatment processes or tracking STI outcome rates do not currently exist in New York State (NYS) hospitals and community health centers.  

Objectives:  To understand facility-level processes for tracking these rates and their usage to assess quality and improve care; to promote the creation of STI homes within healthcare facilities. 

Methods:  The NYS DOH distributed a five-question electronic survey to all senior healthcare facility administrators in NYS via the Health Emergency Response Data System.  Responses were compiled; follow-up calls elicited supplemental information.

Results: The survey response rate was 95% (341/358). Only 45.5% of facilities identify a dedicated person or unit to track and report STIs; 28.5% have an agency-wide process for monitoring STI care; 21.8% have a centralized person/unit coordinating STI management including Infection Control (8%); HIV/ID clinic (2%), with leads including Quality Improvement Directors (4.2%), Infection Prevention Directors (3.1%) and nursing personnel (1.4%).  Departments that most commonly treat STIs include: Emergency Department (58.1%); OB-GYN clinic (50.6%), General Medicine (42.5%) HIV clinic (29.1%), or other (39.7%). 

Conclusions:  Most surveyed facilities report STI infection rates as part of routine surveillance activities but lack systematic methods for monitoring the quality of STI care and outcomes.  Creating STI “homes” within healthcare facilities to promote appropriate care and improve quality is needed as part of a public health (PH) strategy to decrease STI rates. 

Implications for Programs, Policy, and Research:  Healthcare agencies can play an important role in PH initiatives to decrease STI incidence. Integration of STIs into performance improvement programs will facilitate system-level focus on clinical management of STIs and enable use of data to connect healthcare agencies with community wide efforts to both effectively treat and prevent sexually transmitted infections.  In this way, healthcare agencies can be effectively integrated into the network of traditional STI prevention and PH organizations.