HIV Quality of Care Assessment at an Academic Hospital

Rapid changes in HIV treatment guidelines and antiretroviral therapy drug safety data add to the increasing complexity of caring for HIV-infected patients and amplify the need for continuous quality monitoring. The authors created an electronic HIV database of 642 patients who received care in the infectious disease (ID) and general medicine clinics in their academic center to monitor HIV clinical performance indicators. The main outcome measures of the study include process measures, including a description of how the database was constructed, and clinical outcomes, including HIV-specific quality improvement (QI) measures and primary care (PC) measures. Performance on HIV-specific QI measures was very high, but drug toxicity monitoring and PC-specific QI performance were deficient, particularly among ID specialists. Establishment of HIV QI data benchmarks as well as standards for how data will be measured and collected are needed and are the logical counterpart to treatment guidelines.

[1]  S. Bozzette.  Quality of care for patients infected with HIV. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  S. Asch,et al.  Development of national and multiagency HIV care quality measures. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  R. Valdiserri,et al.  National quality forum performance measures for HIV/AIDS care: the Department of Veterans Affairs' experience. , 2010, Archives of internal medicine.

[4]  Sowmya R. Rao,et al.  Use of electronic health records in U.S. hospitals. , 2009, The New England journal of medicine.

[5]  K. Seung,et al.  Lipid Treatment Assessment Project 2: A Multinational Survey to Evaluate the Proportion of Patients Achieving Low-Density Lipoprotein Cholesterol Goals , 2009, Circulation.

[6]  Shazia Kazi,et al.  Assessing Quality of Primary Care Provided to the HIV-Infected Ryan White Population in the Baltimore Eligible Metropolitan Area , 2008, American journal of medical quality : the official journal of the American College of Medical Quality.

[7]  P. Sullivan,et al.  Quality of Care for HIV Infection Provided by Ryan White Program-Supported versus Non-Ryan White Program-Supported Facilities , 2008, PloS one.

[8]  C. Cannon,et al.  An organized approach to improvement in guideline adherence for acute myocardial infarction: results with the Get With The Guidelines quality improvement program. , 2008, Archives of internal medicine.

[9]  T. Brown,et al.  Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. , 2008, The Journal of clinical endocrinology and metabolism.

[10]  Richard D Moore,et al.  Physician specialization and women's primary care services in an urban HIV clinic. , 2008, AIDS patient care and STDs.

[11]  A. Westfall,et al.  Clinical inertia in the management of low-density lipoprotein abnormalities in an HIV clinic. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  D. Abrams,et al.  AIDS-defining and non-AIDS-defining malignancies: cancer occurrence in the antiretroviral therapy era , 2007, Current opinion in oncology.

[13]  A. Westfall,et al.  Nucleoside reverse-transcriptase inhibitor dosing errors in an outpatient HIV clinic in the electronic medical record era. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  M. Suarez‐Almazor,et al.  Retention in care: a challenge to survival with HIV infection. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  J. Polak,et al.  Metabolic syndrome and subclinical atherosclerosis in patients infected with HIV. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  J. Stroup,et al.  Achieving American Diabetes Association Goals in Hiv-Seropositive Patients with Diabetes Mellitus , 2007, Proceedings.

[17]  J. Aberg.  The Changing Face of HIV Care: Common Things Really Are Common , 2006, Annals of Internal Medicine.

[18]  K. Gebo,et al.  Provision of general and HIV-specific health maintenance in middle aged and older patients in an urban HIV clinic. , 2006, AIDS patient care and STDs.

[19]  F. Goebel,et al.  HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  I. Wilson,et al.  Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics. , 2006, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[21]  K. Gallagher,et al.  Predictors of influenza vaccination in HIV-infected patients in the United States, 1990-2002. , 2005, The Journal of infectious diseases.

[22]  S. Weissman,et al.  Differences between infectious diseases-certified physicians and general medicine-certified physicians in the level of comfort with providing primary care to patients. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[23]  I. Wilson,et al.  Physician specialization and the quality of care for human immunodeficiency virus infection. , 2005, Archives of internal medicine.

[24]  A. Zaslavsky,et al.  A National Study of the Relationship of Care Site HIV Specialization to Early Adoption of Highly Active Antiretroviral Therapy , 2005, Medical care.

[25]  V. Stone,et al.  Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine Association of the Infectious Diseases Society of America. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  W. Duffus,et al.  Effect of physician specialty on counseling practices and medical referral patterns among physicians caring for disadvantaged human immunodeficiency virus-infected populations. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[27]  I. Wilson,et al.  Physician specialization and antiretroviral therapy for HIV , 2003, Journal of General Internal Medicine.

[28]  M. Kitahata,et al.  Physician Experience in the Care of HIV‐Infected Persons Is Associated With Earlier Adoption of New Antiretroviral Therapy , 2000, Journal of acquired immune deficiency syndromes.

[29]  J. J. Henning,et al.  Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, January 28, 2000 , 1998, HIV clinical trials.

[30]  P. Ungvarski,et al.  Errors in prescribing HIV-1 protease inhibitors. , 1997, The Journal of the Association of Nurses in AIDS Care : JANAC.

[31]  T. Koepsell,et al.  Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival. , 1996, The New England journal of medicine.

[32]  L. Markson,et al.  AIDS Specialist Versus Generalist Ambulatory Care for Advanced HIV Infection and Impact on Hospital Use , 1994, Medical care.

[33]  Paul Belien,et al.  Healthcare Systems , 2012, PharmacoEconomics.

[34]  G. Moneta.  Lipid Treatment Assessment Project 2: A Multinational Survey to Evaluate the Proportion of Patients Achieving Low-Density Lipoprotein Cholesterol Goals , 2010 .

[35]  B. Thiers.  Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies , 2009 .

[36]  Scott R. Smith,et al.  Adherence counseling practices of generalist and specialist physicians caring for people living with HIV/AIDS in North Carolina , 2007, Journal of General Internal Medicine.

[37]  A. Justice.  Prioritizing primary care in HIV: comorbidity, toxicity, and demography. , 2006, Topics in HIV medicine : a publication of the International AIDS Society, USA.