HSR&D Home » Research » HIT 01-090 – HSR&D Study
Improving HIV Care Quality
Steven M. Asch, MD MPH
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Emily Patterson PhD MS
Cincinnati VA Medical Center, Cincinnati, OH
Funding Period: August 2001 - December 2004
The VA is the largest single provider of HIV care in the United States. The late 1990's have seen a revolution in the quality standards for this disease with the onset of Highly Active Antiretroviral Therapy (HAART) and other developments.
The objective in this project is to develop a method for assessing quality in two important areas of HIV care - antiretroviral medications and opportunistic infection screening and prophylaxis - and explore the determinants of high quality care in order to suggest quality improvement strategies.
The analysis has four parts. First, we described the level of adherence to the indicators in VA HIV patients nationwide and compared VA HIV patients to national benchmarks. Second, we analyzed facility and patient level predictors of adherence to indicators of quality care and compared them with the predictors in the non VA population using staged logistic regressions. Third, we validated certain indicators (e.g., HAART therapy) against clinical outcomes like hospitalization and immune status. We have also modeled the clinical "price" that the VA pays for suboptimal clinical outcomes as a result of current performance levels. Fourth, we compared the performance of the facilities after one year of an intensive targeted indicator-specific feedback group versus those who received aggregate data only.
CR+GBQI facilities improved the proportion of patients with optimal overall care while either modality alone did not (OR=2.65, 95%CI 1.16-6.00). The pattern of improvement of component quality indicators varied. CR+GBQI facilities improved relative to controls on three (hepatitis A, toxoplasmosis screening, immune monitoring) as did CR alone (hepatitis A, toxoplasmosis and lipid screening). GBQI alone improved two endpoints (PCP prophylaxis and immune monitoring) but declined on one (hepatitis B screening).
Within the VA, the results of this analysis will enable us to make concrete suggestions to focus VA quality improvement efforts at the patient, facility, and delivery system level. Outside the VA, predictors of quality within a system where access is more uniformly distributed provoke great interest. We will disseminate the results both though internal VA educational channels and peer reviewed journals.
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DRA: Health Systems
DRE: Treatment - Observational
Keywords: Cost, HIV/AIDS, Translation
MeSH Terms: none