Korner EJ, Bankowitz RA, Cerese JL, Keroack MA, Li T, Wu AW; International Conference on AIDS.

Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. MoPeB3315.

University HealthSystem Consortium, Oak Brook, United States

BACKGROUND: The objective of this study was to assess the variation in care provided to HIV-infected individuals in the ambulatory care setting and identify opportunities for quality improvement. METHODS: Members of the U.S. University HealthSystem Consortium (UHC) and National Association of Public Hospitals (NAPH) were invited to complete a cross-sectional survey on clinic organizational structure and clinical processes, as well as a patient-level medical record abstraction tool. Quality indicators included PCP and MAC prophylaxis for patients with CD4<200 and <50 cells/mm3, respectively; proportion of patients on ART with HIV RNA levels<400 c/mL; receipt of influenza vaccine (annual) and pneumococcal vaccination (ever); women receiving PAP smears; number of emergency department visits and hospitalizations. RESULTS: Thirty-three institutions completed all study requirements and submitted 1,821 cases [median=42.5 cases/institution, range=30-80 cases/institution]. Controlling for prior antiretroviral experience, there was statistically significant between-clinic variation in proportion of patients achieving an HIV RNA<400 c/mL (range= 31%-74%, p<0.0001). A mean of 89.2% [SD=10.9] and 74.2% [SD=25.6] of appropriate patients were prescribed PCP and MAC prophylaxis, respectively. While variation in MAC and PCP prophylaxis rates was observed, these differences were not statistically significant. Controlling for CD4 count, there was significant between-clinic variation in mean number of ED visits/patient (range= 0-1.3, F<0.0001), but not hospitalizations/patient (range= 0.1-2.3, F=0.06). Variation was also observed in flu vaccination (range 13%-85%, p<0.0001), pneumococcal vaccination (range 5% to 100%, p<0.0001) and women receiving PAP smears (range 14%-100%, p=0.0001). CONCLUSION: There are opportunities to reduce practice variation and improve quality of care at participating HIV clinics.

Publication Types:

• Meeting Abstracts

Keywords:

• AIDS Vaccines
• Acquired Immunodeficiency Syndrome
• Ambulatory Care
• Ambulatory Care Facilities
• Anti-HIV Agents
• CD4 Lymphocyte Count
• Cross-Sectional Studies
• Female
• HIV
• HIV Infections
• HIV Seropositivity
• Health Facilities
• Humans
• Influenza Vaccines
• Retrospective Studies
• United States
• Vaccination

Other ID:

• GWAIDS0018678

UI: 102256176

From Meeting Abstracts