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Topal S, Richard P, Young J, Ganesan A, Gleeson T, Blaylock J, Okulicz JF, Chu X, Agan BK. Mandated checkups, knowledge of own health status, and chronic care utilization: The effect of HIV medical evaluation mandates on healthcare quality and expenditure in a US-single payer system. HEALTH ECONOMICS 2024; 33:59-81. [PMID: 37768123 DOI: 10.1002/hec.4761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/21/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
In an effort to improve military readiness, in 2014 the US Air Force reduced the frequency of mandated HIV medical evaluation visits from every 6 months to every 12 months. We employ this natural experiment using data for 2676 active-duty Military Health System beneficiaries living with HIV with a difference-in-differences empirical strategy using the Army, Navy, and Marines as a control group to estimate the causal effect of reducing the frequency of mandated evaluation visits on the quality and cost of medical care for active-duty military members living with HIV. We find that reducing the frequency of mandated HIV medical evaluation visits reduced the likelihood of regular HIV visits by 23 percentage points but did not affect the likelihood of receiving other preventive care, adhering to HIV therapy, or maintaining viral testing and suppression. The study finds evidence that the recommended level of regular HIV visits may be higher than necessary. The reduction in regular HIV visits was not associated with a similar reduction in the studied quality of care measures, therefore, the effect of alleviating the mandate was overall positive in terms of reducing healthcare utilization without adversely affecting preventive care, HIV therapy, or viral testing and suppression.
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Affiliation(s)
- Senay Topal
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - John Young
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anuradha Ganesan
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Todd Gleeson
- Navy Bloodborne Infection Management Center, Bethesda, Maryland, USA
| | - Jason Blaylock
- Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jason F Okulicz
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Xiuping Chu
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Brian K Agan
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
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Tomás-Jiménez M, Roldán-Merino JF, Sanchez-Balcells S, Schröder A, Lundqvist LO, Puig-Llobet M, Moreno-Poyato AR, Domínguez del Campo M, Lluch-Canut MT. Spanish adaptation of the quality in psychiatric care-outpatient (QPC-OP) instrument community mental health patients’ version: psychometric properties and factor structure. BMC Nurs 2022; 21:302. [PMCID: PMC9640787 DOI: 10.1186/s12912-022-01094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Health systems in the field of mental health are strongly committed to community models that allow patients to be attended in their own environment. This helps them to maintain their family and social ties while trying to avoid costly hospital admissions. The patients’ perspective is a key component in the assessment of the quality of psychiatric care and can even determine their adherence to the devices where they are treated. However, there are few instruments with adequate psychometric properties for the evaluation of the quality of psychiatric care in community mental health. The Quality in Psychiatric Care – Outpatient (QPC-OP) instrument has adequate psychometric properties to assess the quality of psychiatric care from the patients’ perspective. The aim of this study was to adapt and validate the Spanish version of the QPC-OP instrument. Methods A translation and back-translation of the instrument was carried out. To examine its psychometric properties, the instrument was administered to 200 patients attending various community mental health services. To assess test-retest reliability, the instrument was readministered after 7-14 days (n = 98). Results The Confirmatory Factor Analysis revealed a structure of 8 factors identical to the original version, with an adequate model fit. The internal consistency coefficient (Cronbach’s alpha) was 0.951. The intraclass correlation coefficient was 0.764 (95% IC: 0.649 – 0.842), and higher than 0.70 in 5 of the 8 factors. Additionally, an EFA was performed and revealed that the instrument could behave in a unifactorial or four factor manner in the sample analyzed. Conclusions Results show that the Spanish version of the QPC-OP instrument is valid and reliable for the assessment of quality of psychiatric care in the community setting.
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Affiliation(s)
- Manuel Tomás-Jiménez
- grid.466982.70000 0004 1771 0789Parc Sanitari Sant Joan de Déu. Sant Boi de Llobregat, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Mental Health Department, Campus Docent Sant Joan de Déu-Private Foundation, University of Barcelona, C/ Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
| | - Juan Francisco Roldán-Merino
- grid.5841.80000 0004 1937 0247Mental Health Department, Campus Docent Sant Joan de Déu-Private Foundation, University of Barcelona, C/ Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
| | - Sara Sanchez-Balcells
- grid.466982.70000 0004 1771 0789Parc Sanitari Sant Joan de Déu. Sant Boi de Llobregat, Barcelona, Spain
| | - Agneta Schröder
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden ,grid.5947.f0000 0001 1516 2393Department of Nursing, Faculty of Health Care and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars-Olov Lundqvist
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Montserrat Puig-Llobet
- grid.5841.80000 0004 1937 0247Public Health, Mental Health and Maternal-Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio R. Moreno-Poyato
- grid.5841.80000 0004 1937 0247Public Health, Mental Health and Maternal-Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Domínguez del Campo
- grid.466982.70000 0004 1771 0789Parc Sanitari Sant Joan de Déu. Sant Boi de Llobregat, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Mental Health Department, Campus Docent Sant Joan de Déu-Private Foundation, University of Barcelona, C/ Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
| | - Maria Teresa Lluch-Canut
- grid.5841.80000 0004 1937 0247Public Health, Mental Health and Maternal-Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Erratum to: Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2021; 74:1893-1898. [PMID: 34878522 DOI: 10.1093/cid/ciab801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tulika Singh
- Internal Medicine, HIV and Infectious Disease, Desert AIDS Project, Palm Springs, California, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Mount Sinai Health System, New York, New York, USA
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DelaCruz JJ, Brennan-Ing M, Kakolyris A, Martinez O. The Cost Effectiveness of Mental Health Treatment in the Lifetime of Older Adults with HIV in New York City: A Markov Approach. PHARMACOECONOMICS - OPEN 2021; 5:221-236. [PMID: 33165825 PMCID: PMC7649900 DOI: 10.1007/s41669-020-00238-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND There are noticeable gaps in knowledge regarding the cost and effectiveness of integrated medical and behavioral services for older adults with HIV. Their lifespan is close to the population's level but their quality of life has sharply declined due to depression and substance use. Mental health disorders are widespread among an aging population with HIV. OBJECTIVE The aim of this study was to build a decision analytic model to evaluate medical interventions with and without mental health treatment using primary data of 139 older adults with HIV and health outcomes from the literature. METHODS We tracked the progression of depression and cumulative deaths among older adults with HIV using a Markov model with 50 annual cycles through three health states. Deterministic and probabilistic sensitivity analyses addressed uncertainty in estimating the parameters and around the model's assumptions. RESULTS An integrated medical and behavioral care system is cost effective at a willingness to pay of $50,000 per QALY compared with medical care only. The incremental cost was $516,452 and the incremental effectiveness was 38.8 quality-adjusted life-years (QALY), with an incremental cost-effectiveness ratio of $13,316 per QALY. CONCLUSIONS Appropriate and efficacious referrals to integrated medical + behavioral services, either in the same facility or connected to their primary care doctor, are instrumental to reverse loses in quality of life and avoid premature death. If mental health is left unattended, HIV would progress, causing declines in quality of life and ultimately triggering premature death. Reliable data on the cost and effectiveness of different types of HIV integrated services are needed.
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Affiliation(s)
- Juan J. DelaCruz
- Department of Economics and Business, Lehman College, CUNY, 250 Bedford Park Blvd W, Bronx, NY USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, CUNY, 2180 Third Avenue, 8th Floor, New York, NY 10035 USA
| | - Andreas Kakolyris
- Department of Economics and Finance, Manhattan College, 4513 Manhattan College Parkway, Room DLS 505, Bronx, NY USA
| | - Omar Martinez
- College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 505, Philadelphia, PA USA
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Olivieri-Mui B, McGuire J, Griffith J, Cahill S, Briesacher B. Exploring the Association Between the Quality of HIV Care in Nursing Homes and Hospitalization. J Healthc Qual 2021; 43:174-182. [PMID: 32658007 PMCID: PMC7790902 DOI: 10.1097/jhq.0000000000000277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. We assessed HIV care quality with four national measures adapted for the NH setting. We applied the measures to 2011-2013 Medicare claims linked to Minimum Data Set assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Cox proportional hazards models calculated the risk of all-cause and HIV/AIDS-related hospitalization by HIV care compliance. We identified 1,246 PLWH in 201 NHs with 382 all-cause and 63 HIV/AIDS-related hospitalizations. Nursing home HIV care compliance varied from 24.9% to 64.7%. After regression adjustment, we could detect no difference in all-cause or HIV/AIDS-related hospitalizations by NH HIV care compliance. We postulate that the lack of association may be due to inappropriate HIV care quality measures that do not accurately represent NHs ability to care for PLWH. There is urgent need to create valid NH HIV care quality measures.
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Lin ECL, Hsiao FH, Schröder A, Lundqvist LO, Chao HL, Lee SK, Hung TM, Lu MJ, Lu HL, Laio SJ, Chang KY, Pan AN. Factors influencing patient-perceived quality of care in psychiatric hospitals in Taiwan. Arch Psychiatr Nurs 2021; 35:9-16. [PMID: 33593521 DOI: 10.1016/j.apnu.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
Patient-perceived quality of inpatient/outpatient psychiatric care remains under-researched. A cross-sectional survey with purposive sampling comprising 567 inpatients and 549 outpatients was conducted among eight psychiatric care facilities in Taiwan to examine the factors influencing patient-perceived care quality. Inpatients and outpatients perceived moderate quality of care, where "Encounter" was reported as the highest dimension. Inpatients perceived "Secure environment" as the lowest; outpatients rated "Discharge/Referring" as the lowest. Hospital region and customer loyalty were significantly associated with patient-perceived care quality. Other significant factors were also identified: inpatient employment, perceived mental health and treatment effects, understanding diagnosis, previous treatment, and visited by appointment.
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Affiliation(s)
- Esther Ching-Lan Lin
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan.
| | - Fei-Hsiu Hsiao
- National Taiwan University College of Medicine School of Nursing, Taipei, Taiwan; National Taiwan University Hospital Nursing Department, Taipei, Taiwan
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Health Science, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hui-Lin Chao
- Nursing Department, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Tsaotun Township, Nantou County 542, Taiwan
| | - Tsui-Mei Hung
- Nursing Department, Songde Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Mei-Jou Lu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Huei-Lan Lu
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan City, Taiwan
| | - Su-Jung Laio
- Yuli Hospital, Ministry of Health and Welfare, Taiwan; Department of Nursing, Tzu Chi University of Science and Technology, Taiwan
| | | | - An-Nie Pan
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
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Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2020; 73:e3572-e3605. [PMID: 33225349 DOI: 10.1093/cid/ciaa1391] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a near expected life span, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the life span. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates previous 2013 primary care guidelines.
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Affiliation(s)
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tulika Singh
- Internal Medicine, HIV and Infectious Disease, Desert AIDS Project, Palm Springs, California, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Mount Sinai Health System, New York, New York, USA
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Horberg MA, Certa JM, Rubenstein KB, Hurley LB, Satre DD, Kadlecik PM, Silverberg MJ. Beyond the HIV Care Continuum and Viral Suppression: Broadening the Scope of Quality Metrics for Total HIV Patient Care. AIDS Patient Care STDS 2020; 34:461-469. [PMID: 33147087 PMCID: PMC7698986 DOI: 10.1089/apc.2020.0145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Assessing quality care for people with HIV (PWH) should not be limited to reporting on HIV Care Continuum benchmarks, particularly viral suppression rates. At Kaiser Permanente Mid-Atlantic States (KPMAS), an integrated health system providing HIV care in the District of Columbia, Maryland, and Virginia, we created a comprehensive measure of HIV quality care, including both preventative measures and clinical outcomes. We included PWH ≥18 years old with ≥6 months KPMAS membership between 2015 and 2018. Process quality metrics (QMs) include: pneumococcal vaccination and influenza vaccination; primary care physician (PCP) and/or HIV/infectious disease (HIV/ID) visits with additional HIV/ID visit; antiretroviral treatment medication fills; and syphilis and gonorrhea/chlamydia screenings. Outcome QMs include HIV RNA <200/mL and other measurements within normal range [blood pressure, body mass index (BMI), hemoglobin, blood sugar, alanine transaminase, low-density lipoproteins, estimated glomerular filtration rate]; no hospitalization/emergency department visit; no new depression diagnosis; remaining or becoming a nonsmoker. Logistic models estimated odds of achieving QMs associated with sex, age, race/ethnicity, insurance type, and HIV risk. A total of 4996 observations were analyzed. 45.6% met all process QMs, while 19.6% met all outcome QMs. Least frequently met process QM was PCP or HIV/ID visit (74.5%); least met outcome QM was BMI (60.2%). Significantly lower odds of achieving all QMs among women {odds ratio (OR) = 0.63 [95% confidence interval (CI): 0.49-0.81]} and those with Medicaid and Medicare [vs. commercial; OR = 0.48 (95% CI: 0.30-0.76) and 0.47 (95% CI: 0.31-0.71)]. Broadening the scope of HIV patient care QMs beyond viral suppression helps identify opportunities for improvement. Successful process metrics do not necessarily coincide with greater outcome metrics.
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Affiliation(s)
- Michael A. Horberg
- Kaiser Permanente Mid-Atlantic States Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Julia M. Certa
- Kaiser Permanente Mid-Atlantic States Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Kevin B. Rubenstein
- Kaiser Permanente Mid-Atlantic States Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Leo B. Hurley
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Derek D. Satre
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Peter M. Kadlecik
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Michael J. Silverberg
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
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McKellar MS, Kuchibhatla MN, Oursler KAK, Crystal S, Akgün KM, Crothers K, Gibert CL, Nieves-Lugo K, Womack J, Tate JP, Fillenbaum GG. Racial Differences in Change in Physical Functioning in Older Male Veterans with HIV. AIDS Res Hum Retroviruses 2019; 35:1034-1043. [PMID: 30963773 DOI: 10.1089/aid.2018.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Little is known about longitudinal change in physical functioning of older African American/Black and White HIV-infected persons. We examined up to 10 years of data on African American (N = 1,157) and White (N = 400) men with HIV infection and comparable HIV-negative men (n = 1,137 and 530, respectively), age 50-91 years from the Veterans Aging Cohort Study Survey sample. Physical functioning was assessed using the SF-12 (12-Item Short Form Health Survey) physical component summary (PCS) score. Mixed-effects models examined association of demographics, health conditions, health behaviors, and selected interactions with PCS score; HIV biomarkers were evaluated for HIV-infected persons. PCS scores were approximately one standard deviation below that of the general U.S. population of similar age. Across the four HIV/race groups, over time and through ages 65-75 years, PCS scores were maintained; differences were not clinically significant. PCS score was not associated with race or with interactions among age, race, and HIV status. CD4 and viral load counts of African American and White HIV-infected men were similar. Older age, low socioeconomic status, chronic health conditions and depression, lower body mass index, and smoking were associated with poorer PCS score in both groups. Exercising and, counterintuitively, being HIV infected were associated with better PCS score. Among these older African American and White male veterans, neither race nor HIV status was associated with PCS score, which remained relatively stable over time. Chronic disease, depression, and lack of exercise were associated with lower PCS score. To maintain independence in this population, attention should be paid to controlling chronic conditions, and emphasizing good health behaviors.
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Affiliation(s)
- Mehri S. McKellar
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | | | - Kris Ann K. Oursler
- Department of Internal Medicine, Salem Veterans Affairs Medical Center, Salem, Virginia
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Kathleen M. Akgün
- Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kristina Crothers
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Cynthia L. Gibert
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Karen Nieves-Lugo
- Department of Psychology, George Washington University, Washington, District of Columbia
| | - Julie Womack
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Nursing, New Haven, Connecticut
| | - Janet P. Tate
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Gerda G. Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
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10
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Kraemer KL, McGinnis KA, Fiellin DA, Skanderson M, Gordon AJ, Robbins J, Zickmund S, Bryant K, Korthuis PT. Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans. J Subst Abuse Treat 2019; 103:23-32. [PMID: 31229189 DOI: 10.1016/j.jsat.2019.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) are common in healthcare settings and contribute to poor outcomes, particularly in patients living with HIV. We assessed initiation, engagement, and retention in SUD treatment and pharmacotherapy following an index SUD episode in a national sample of HIV-infected and uninfected patients receiving care in the Department of Veterans Affairs (VA) healthcare system. METHODS We used electronic national VA data (years 2000-2015) from 52,995 HIV-infected and 111,229 age-, race-, gender-, and region-matched uninfected patients. We defined index SUD episodes as outpatient visits or inpatient/residential admissions with associated primary or secondary ICD-9 codes for substance use in patients without SUD-related services or pharmacotherapy in the preceding 5 months. RESULTS Overall, 57,428 (35%) patients had at least 1 index SUD episode. HIV-infected patients were more likely than uninfected controls to have at least one index SUD episode (35.7% vs. 34.6%; p < .001). Rates of initiation, engagement, and retention in SUD treatment after the index SUD episode were <17% for both groups. In adjusted models, HIV-infected patients were more likely than uninfected patients to be retained in SUD treatment at 6 months (Odds Ratio 1.10; 95% Confidence Interval 1.04-1.16). SUD pharmacotherapy initiation and engagement was uncommon in both HIV-infected and uninfected patients. CONCLUSIONS In this national VA sample, initiation of SUD treatment and pharmacotherapy were uncommon for both HIV-infected and uninfected patients. Interventions to improve initiation, engagement, and retention in the full range of services, including SUD pharmacotherapy, are warranted for all patients with SUD in the VA.
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Affiliation(s)
- Kevin L Kraemer
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States; VA Pittsburgh Healthcare System, 4100 Allequippa Street, Pittsburgh, PA 15213, United States.
| | - Kathleen A McGinnis
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar Street, Boardman 110, P.O. Box 208056, New Haven, CT 06520-8056, United States
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar Street, Boardman 110, P.O. Box 208056, New Haven, CT 06520-8056, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510-2483, United States
| | - Melissa Skanderson
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar Street, Boardman 110, P.O. Box 208056, New Haven, CT 06520-8056, United States
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States
| | - Jonathan Robbins
- Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098, United States
| | - Susan Zickmund
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892-6902, United States
| | - P Todd Korthuis
- Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098, United States
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11
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Terzian AS, Younes N, Greenberg AE, Opoku J, Hubbard J, Happ LP, Kumar P, Jones RR, Castel AD. Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression. AIDS Behav 2018; 22:3009-3023. [PMID: 29603112 DOI: 10.1007/s10461-018-2103-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.
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Affiliation(s)
- A S Terzian
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
| | - N Younes
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - J Opoku
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - J Hubbard
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - L P Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - P Kumar
- School of Medicine, Georgetown University, Washington, DC, USA
| | - R R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
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12
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Adams JW, Bryant KJ, Edelman EJ, Fiellin DA, Gaither JR, Gordon AJ, Gordon KS, Kraemer KL, Mimiaga MJ, Operario D, Tate JP, van den Berg JJ, Justice AC, Marshall BDL. Association of Cannabis, Stimulant, and Alcohol use with Mortality Prognosis Among HIV-Infected Men. AIDS Behav 2018; 22:1341-1351. [PMID: 28887669 DOI: 10.1007/s10461-017-1905-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Questionnaires over a 9-year study period (2002-2010) were used to characterize cannabis, stimulant, and alcohol use among 3099 HIV-infected men participating in the Veterans Aging Cohort Study (VACS) to determine whether use of these substances is associated with changes in the VACS Index, a validated prognostic indicator for all-cause mortality. At baseline, 18% of participants reported no substance use in the past year, 24% lower risk alcohol use only, 18% unhealthy alcohol use only, 15% cannabis use (with or without alcohol), and 24% stimulant use (with or without alcohol or cannabis). In adjusted longitudinal analyses, cannabis use [β = -0.97 (95% CI -1.93, 0.00), p = 0.048] was not associated with mortality risk, while stimulant use [1.08 (0.16, 2.00), p = 0.021] was associated with an increased mortality risk, compared to lower risk alcohol use. Our findings show no evidence of a negative effect of cannabis use on mortality risk, while stimulant use was associated with increased mortality risk among HIV-infected men. Interventions to reduce stimulant use in this patient population may reduce mortality.
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Affiliation(s)
- Joëlla W Adams
- Brown University School of Public Health, Providence, RI, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA
| | - E Jennifer Edelman
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
| | - David A Fiellin
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
| | - Julie R Gaither
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kirsha S Gordon
- Veterans Aging Cohort Study Coordinating Center, Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | | | | | - Don Operario
- Brown University School of Public Health, Providence, RI, USA
| | - Janet P Tate
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
- Veterans Aging Cohort Study Coordinating Center, Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | | | - Amy C Justice
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
- Veterans Aging Cohort Study Coordinating Center, Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
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13
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Castel AD, Terzian A, Hart R, Rayeed N, Kalmin MM, Young H, Greenberg AE. Use of national standards to monitor HIV care and treatment in a high prevalence city-Washington, DC. PLoS One 2017; 12:e0186036. [PMID: 28982127 PMCID: PMC5628915 DOI: 10.1371/journal.pone.0186036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/22/2017] [Indexed: 12/25/2022] Open
Abstract
We sought to benchmark the quality of HIV care being received by persons living with HIV in care in Washington, DC and identify individual-level and structural-level differences. Data from the DC Cohort, an observational HIV cohort of persons receiving outpatient care in DC, were used to estimate the Institute of Medicine (IOM) and Department of Health and Human Services (HHS) quality of care measures. Differences in care by demographics and clinic type were assessed using χ2 tests and multivariable regression models. Among 8,047 participants, by HHS standards, 69% of participants were retained in care (RIC), 95% were prescribed antiretroviral therapy (ART), and 84% were virally suppressed (VS). By IOM standards, 84% were in continuous care; and 78% and 80% underwent regular CD4 and VL monitoring, respectively. Screening for syphilis, chlamydia, and gonorrhea was 51%, 31%, and 26%, respectively. Older participants were 1.5 times more likely to be RIC compared to younger participants (OR: 1.5; 95% CI: 1.3, 1.8). Participants enrolled in community-based clinics were more likely to be RIC (OR: 1.7; 95% CI: 1.4, 2.0) versus those enrolled at hospital-based clinics. Older participants were more likely to achieve VS than younger participants (OR: 1.8; 95% CI: 1.5, 2.2) while Black participants were less likely compared to white participants (OR: 0.4; 95% CI: 0.3, 0.5). Despite high measures of quality of care, disparities remain. Continued monitoring of the quality of HIV care and treatment can inform the development of public health programs and interventions to optimize care delivery.
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Affiliation(s)
- Amanda D. Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC., United States of America
| | - Arpi Terzian
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC., United States of America
| | - Rachel Hart
- Cerner Corporation, Kansas City, Missouri, United States of America
| | - Nabil Rayeed
- Cerner Corporation, Kansas City, Missouri, United States of America
| | - Mariah M. Kalmin
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC., United States of America
| | - Heather Young
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC., United States of America
| | - Alan E. Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC., United States of America
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14
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KORTHUIS PT, LUM PJ, VERGARA-RODRIGUEZ P, AHAMAD K, WOOD E, KUNKEL LE, ODEN NL, LINDBLAD R, SORENSEN JL, ARENAS V, Doan HA, MANDLER RN, MCCARTY D. Feasibility and safety of extended-release naltrexone treatment of opioid and alcohol use disorder in HIV clinics: a pilot/feasibility randomized trial. Addiction 2017; 112:1036-1044. [PMID: 28061017 PMCID: PMC5408318 DOI: 10.1111/add.13753] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/14/2016] [Accepted: 01/04/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS HIV-infected people with substance use disorders are least likely to benefit from advances in HIV treatment. Integration of extended-release naltrexone (XR-NTX) into HIV clinics may increase engagement in the HIV care continuum by decreasing substance use. We aimed to compare (1) XR-NTX treatment initiation, (2) retention and (3) safety of XR-NTX versus treatment as usual (TAU) for treating opioid use disorder (OUD) and/or alcohol use disorder (AUD) in HIV clinics. DESIGN Non-blinded randomized trial of XR-NTX versus pharmacotherapy TAU. SETTING HIV primary care clinics in Vancouver, BC, Canada and Chicago, IL, USA. PARTICIPANTS Fifty-one HIV-infected patients seeking treatment for OUD (n = 16), AUD (n = 27) or both OUD and AUD (n = 8). MEASUREMENTS Primary outcomes were XR-NTX initiation (receipt of first injection within 4 weeks of randomization) and retention at 16 weeks. Secondary outcomes generated point estimates for change in substance use, HIV viral suppression [HIV RNA polymerase chain reaction (pcr) < 200 copies/ml] and safety. FINDINGS Two-thirds (68%) of participants assigned to XR-NTX initiated treatment, and 88% of these were retained on XR-NTX at 16 weeks. In comparison, 96% of TAU participants initiated treatment, but only 50% were retained on medication at 16 weeks. Mean days of opioid use in past 30 days decreased from 17.3 to 4.1 for TAU and from 20.3 to 7.7 for XR-NTX. Mean heavy drinking days decreased from 15.6 to 5.7 for TAU and 12.5 to 2.8 for XR-NTX. Among those with OUD, HIV suppression improved from 67 to 80% for XR-NTX and 58 to 75% for TAU. XR-NTX was well tolerated, with no precipitated withdrawals and one serious injection-site reaction. CONCLUSIONS Extended-release naltrexone (XR-NTX) is feasible and safe for treatment of opioid use disorder and alcohol use disorder in HIV clinics. Treatment initiation appears to be lower and retention greater for XR-NTX compared with treatment as usual (clinicaltrials.gov NCT01908062).
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Affiliation(s)
| | - Paula J. LUM
- University of California, San Francisco, San Francisco, CA
| | | | - Keith AHAMAD
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC,University of British Columbia, Vancouver, BC
| | - Evan WOOD
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC,University of British Columbia, Vancouver, BC
| | | | | | | | | | | | - HA Doan
- Oregon Health & Science University, Portland, OR
| | - Raul N. MANDLER
- National Institutes of Health, National Institute on Drug Abuse
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15
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Abstract
Objective: To assess associations between engagement in-care and future mortality. Design: UK-based observational cohort study. Methods: HIV-positive participants with more than one visit after 1 January 2000 were identified. Each person-month was classified as being in or out-of-care based on the dates of the expected and observed next care visits. Cox models investigated associations between mortality and the cumulative proportion of months spent in-care (% IC, lagged by 1 year), and cumulative %IC prior to antiretroviral therapy (ART) in those attending clinic for more than 1 year, with adjustment for age, CD4+/viral load, year, sex, infection mode, ethnicity, and receipt/type of ART. Results: The 44 432 individuals (27.8% women; 50.5% homosexual, 28.9% black African; median age 36 years) were followed for a median of 5.5 years, over which time 2279 (5.1%) people died. Higher %IC was associated with lower mortality both before [relative hazard 0.91 (95% confidence interval 0.88–0.95)/10% higher, P = 0.0001] and after [0.90 (0.87–0.93), P = 0.0001] adjustment. Adjustment for future CD4+ changes revealed that the association was explained by poorer CD4+ cell counts in those with lower %IC. In total 8730 participants under follow-up for more than 1 year initiated ART of whom 237 (2.7%) died. Higher values of %IC prior to ART initiation were associated with a reduced risk of mortality before [0.29 (0.17–0.47)/10%, P = 0.0001] and after [0.36 (0.21–0.61)/10%, P = 0.0002] adjustment; the association was again explained by poorer post-ART CD4+/ viral load in those with lower pre-ART %IC. Conclusions: Higher levels of engagement in-care are associated with reduced mortality at all stages of infection, including in those who initiate ART.
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16
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Blanco JR, Von Wichmann MA. Quality indicators: A tool to improve efficiency. Enferm Infecc Microbiol Clin 2017; 35:65-66. [DOI: 10.1016/j.eimc.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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17
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Rhodes CM, Chang Y, Regan S, Singer DE, Triant VA. Human Immunodeficiency Virus (HIV) Quality Indicators Are Similar Across HIV Care Delivery Models. Open Forum Infect Dis 2017; 4:ofw240. [PMID: 28480238 DOI: 10.1093/ofid/ofw240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are limited data on human immunodeficiency virus (HIV) quality indicators according to model of HIV care delivery. Comparing HIV quality indicators by HIV care model could help inform best practices because patients achieving higher levels of quality indicators may have a mortality benefit. METHODS Using the Partners HIV Cohort, we categorized 1565 patients into 3 HIV care models: infectious disease provider only (ID), generalist only (generalist), or infectious disease provider and generalist (ID plus generalist). We examined 12 HIV quality indicators used by 5 major medical and quality associations and grouped them into 4 domains: process, screening, immunization, and HIV management. We used generalized estimating equations to account for most common provider and multivariable analyses adjusted for prespecified covariates to compare composite rates of HIV quality indicator completion. RESULTS We found significant differences between HIV care models, with the ID plus generalists group achieving significantly higher quality measures than the ID group in HIV management (94.4% vs 91.7%, P = .03) and higher quality measures than generalists in immunization (87.8% vs 80.6%, P = .03) in multivariable adjusted analyses. All models achieved rates that equaled or surpassed previously reported quality indicator rates. The absolute differences between groups were small and ranged from 2% to 7%. CONCLUSIONS Our results suggest that multiple HIV care models are effective with respect to HIV quality metrics. Factors to consider when determining HIV care model include healthcare setting, feasibility, and physician and patient preference.
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Affiliation(s)
- Corinne M Rhodes
- University of Pennsylvania, Division of General Internal Medicine, Philadelphia, Pennsylvania; Massachusetts General Hospital, Divisions of
| | - Yuchiao Chang
- General Internal Medicine.,Harvard Medical School, Boston, Massachusetts
| | - Susan Regan
- General Internal Medicine.,Harvard Medical School, Boston, Massachusetts
| | - Daniel E Singer
- General Internal Medicine.,Harvard Medical School, Boston, Massachusetts
| | - Virginia A Triant
- General Internal Medicine.,Infectious Diseases, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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18
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Feller DJ, Agins BD. Understanding Determinants of Racial and Ethnic Disparities in Viral Load Suppression. J Int Assoc Provid AIDS Care 2016; 16:23-29. [PMID: 27629866 DOI: 10.1177/2325957416667488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Racial and ethnic disparities in viral load suppression (VLS) have been well documented among people living with HIV (PLWH). The authors hypothesized that a contemporary analytic technique could reveal factors underlying these disparities and provide more explanatory power than broad stereotypes. Classification and regression tree analysis was used to detect factors associated with VLS among 11 419 adult PLWH receiving treatment from 186 New York State HIV clinics in 2013. A total of 8885 (77.8%) patients were virally suppressed. The algorithm identified 8 mutually exclusive subgroups characterized by age, housing stability, drug use, and insurance status but neither race nor ethnicity. Our findings suggest that racial and ethnic disparities in VLS exist but likely reflect underlying social and behavioral determinants of health.
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Affiliation(s)
- Daniel J Feller
- 1 New York State Department of Health AIDS Institute, New York, NY, USA
| | - Bruce D Agins
- 1 New York State Department of Health AIDS Institute, New York, NY, USA
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19
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Delgado-Mejía E, Frontera-Juan G, Murillas-Angoiti J, Campins-Roselló AA, Gil-Alonso L, Peñaranda-Vera M, Ribas Del Blanco MA, Martín-Pena ML, Riera-Jaume M. [GeSIDA quality care indicators associated with mortality and hospital admission for the care of persons infected by HIV/AIDS]. Enferm Infecc Microbiol Clin 2016; 35:67-75. [PMID: 27270265 DOI: 10.1016/j.eimc.2016.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In 2010, the AIDS Study Group (Grupo de Estudio del SIDA [GESIDA]) developed 66 quality care indicators. The aim of this study is to determine which of these indicators are associated with mortality and hospital admission, and to perform a preliminary assessment of a prediction rule for mortality and hospital admission in patients on treatment and follow-up. METHODS A retrospective cohort study was conducted in the Hospital Universitario Son Espases (Palma de Mallorca, Spain). Eligible participants were patients with human immunodeficiency syndrome≥18 years old who began follow-up in the Infectious Disease Section between 1 January 2000 and 31 December 2012. A descriptive analysis was performed to evaluate anthropometric variables, and a logistic regression analysis to assess the association between GESIDA indicators and mortality/admission. The mortality probability model was built using logistic regression. RESULTS A total of 1,944 adults were eligible (median age: 37 years old, 78.8% male). In the multivariate analysis, the quality of care indicators associated with mortality in the follow-up patient group were the items 7, 16 and 20, and in the group of patients on treatment were 7, 16, 20, 35, and 38. The quality of care indicators associated with hospital admissions in the follow-up patients group were the same as those in the mortality analysis, plus number 31. In the treatment group the associated quality of care indicators were items 7, 16, 20, 35, 38, and 40. CONCLUSIONS Some GeSIDA quality of care indicators were associated with mortality and/or hospital admissions. These indicators are associated with delayed diagnosis, regular monitoring, prevention of infections, and control of comorbidities.
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20
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Horberg MA. HIV Quality Measures and Outcomes: The Next Phase. Clin Infect Dis 2015; 62:240-1. [PMID: 26338784 DOI: 10.1093/cid/civ765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michael A Horberg
- Research, Community Benefit, and Medical Strategy, Mid-Atlantic Permanente Medical Group HIV/AIDS, Kaiser Permanente, Rockville, Maryland
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