Measuring HIV Quality of Care
Steven M. Asch MD MPH
VA Greater Los Angeles Healthcare System
Los Angeles, 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.

PUBLICATIONS:

Journal Articles

1. Asch SM, Fremont AM, Turner BJ, Gifford A, McCutchan JA, Mathews WM, Bozzette SA, Shapiro MF. Symptom-based framework for assessing quality of HIV care. International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua. 2004; 16(1): 41-50.
2. Patterson ES, Nguyen AD, Halloran JP, Asch SM. Human factors barriers to the effective use of ten HIV clinical reminders. Journal of The American Medical Informatics Association : JAMIA. 2004; 11(1): 50-9.
3. Bozzette SA, Gifford AL. The economic viability of antiretroviral adherence interventions. American Journal of Medicine. 2003; 115(8): 672-3.
4. Bozzette SA, Phillips B, Asch S, Gifford AL, Lenert L, Menke T, Ortiz E, Owens D, Deyton L. Quality Enhancement Research Initiative for human immunodeficiency virus/acquired immunodeficiency syndrome: framework and plan. HIV-QUERI Executive Committee. Medical Care. 2000; 38(6 Suppl 1): I60-9.

DRA: Chronic Diseases, Health Services and Systems
DRE: Quality of Care
Keywords: HIV/AIDS, Quality assessment
MeSH Terms: Chronic Disease, Quality Assurance, Health Care, Quality of Health Care, Delivery of Health Care, Integrated, Health Care Evaluation Mechanisms, HIV, Total Quality Management