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HIS 99-042 – HSR Study

 
HIS 99-042
Measuring HIV Quality of Care
Steven M. Asch, MD MPH
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Samuel Bozzette MD PhD
VA San Diego Healthcare System, San Diego, CA
San Diego, CA
Funding Period: July 2000 - June 2003
BACKGROUND/RATIONALE:
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.

OBJECTIVE(S):
Our purpose 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.

METHODS:
The analysis has four parts. First, it will describe the level of adherence to the indicators in VA HIV patients nationwide and compare VA HIV patients to national benchmarks. Second, it will analyze facility and patient level predictors of adherence to indicators of quality of care and compare them with the predictors in the non VA population using staged logistic regressions. Third, it will seek to validate certain indicators (e.g. HAART therapy) against clinical outcomes like hospitalization and immune status. We will also model the clinical "price" that the VA pays in suboptimal clinical outcomes as a result of current performance levels. Fourth, we will compare the performance of the facilities after one year of an intensive targeted indicator-specific feedback group versus those receiving aggregate data only.

FINDINGS/RESULTS:
No findings at this time

IMPACT:
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.


External Links for this Project

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PUBLICATIONS:

None at this time.


DRA: Health Systems
DRE: none
Keywords: HIV/AIDS, Quality assessment
MeSH Terms: Quality Assurance, Health Care, Quality of Health Care, Delivery of Health Care, Integrated, Health Care Evaluation Mechanisms, HIV, Total Quality Management, Chronic Disease

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