Measuring HIV Quality of Care
Summary
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.
Description
Background:
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.
Objectives:
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.
Status:
Data analysis.
Study Design
N/A
Conditions
HIV Positive
Location
VA San Diego Health Care System
San Diego
California
United States
92161
Status
Completed
Source
Department of Veterans Affairs
Results (where available)
Links
- Source: http://clinicaltrials.gov/show/NCT00012701
- Information obtained from ClinicalTrials.gov on August 23, 2012
Medical and Biotech [MESH] Definitions
Positive-pressure Respiration, Intrinsic
Non-therapeutic positive end-expiratory pressure occurring frequently in patients with severe airway obstruction. It can appear with or without the administration of external positive end-expiratory pressure (POSITIVE-PRESSURE RESPIRATION). It presents an important load on the inspiratory muscles which are operating at a mechanical disadvantage due to hyperinflation. Auto-PEEP may cause profound hypotension that should be treated by intravascular volume expansion, increasing the time for expiration, and/or changing from assist mode to intermittent mandatory ventilation mode. (From Harrison's Principles of Internal Medicine, 12th ed, p1127)
Ions
An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as CATIONS; those with a negative charge are ANIONS.
Intermittent Positive-pressure Breathing
Application of positive pressure to the inspiratory phase of spontaneous respiration.
Intermittent Positive-pressure Ventilation
Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator.
Gram-positive Asporogenous Rods
A gram-positive, non-spore-forming group of bacteria comprising organisms that have morphological and physiological characteristics in common.
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