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Quality measurement of ambulatory HIV clinical care in New York State (NYS).


Int Conf AIDS. 1996 Jul 7-12;11(2):19 (abstract no. We.B.175). Unique

Objective: To evaluate the quality of care provided to persons with HIV in NYS, and compare clinical practice patterns among different demographic groups of patients receiving care in hospital clinics, community health centers and drug-treatment programs. Method: Data abstraction from medical records of 1,975 patients in 81 facilities cared for in 1993, and 2,251 patients in 78 facilities cared for in 1994 was performed by patient record analysts. Peer-defined NYS practice guidelines for HIV ambulatory care have been translated into algorithms and review criteria for evaluating quality of care that include specific performance indicators for CD4 count measurement, antiretroviral therapy (ARV), pneumocystis (PCP) prophylaxis, PPD screening, pelvic exam and PAP smear. Performance data were analyzed and compared according to gender, exposure category, region and health care facility type using multivariate analysis. Data from 1995 will be available for presentation. Clinical guidelines, algorithms and review criteria will also be displayed. Results: Recording of CD4 count improved significantly (p is less than 0.001) from 87.8%(n=1975) to 96.0% (n=2251) whereas PCP prophylaxis remained consistent at 91.4% p=0.936;n=898[1993];1152 [1994]). PPD performance improved significantly (p is less than 0.001) from 60.3%(n=1935; to 77.2%(n=1258), with highest rates of performance observed in HIV primary care programs co-located in drug treatment centers. Anergy testing performance rates improved significantly (p is less than 0.001) from 77.5% (n=897) to 92.7% (n=812). Performance of pelvic exam also improved significantly (p is less than 0.0001) from 64.6% (n=924) to 76.1%(n=1006). Use of ARV in patients with fewer than 200 CD4 cells/cumm declined significantly (p is less than 0.001) from 84.2%(n=898) to 62.0%(n=1152). Intravenous drug users were more likely to receive ARV than men who have sex with men (p=0.014; 1994). Patients receiving care in community health centers were more likely to receive ARV than those enrolled in specialty hospital clinics p=0.006). Conclusions: Trends in performance of clinical peer-defined HIV ambulatory care quality performance measures showed significant improvement among all groups in NYS except in the use of ARV, where significant decline was observed in all groups between 1993-4. Dissemination of clinical practice guidelines, release of comparative and normative quality measurement data, targeted clinical education and technical assistance contributed to improved performance. The cause of diminished ARV use is being evaluated. Clinical performance did not differ consistently between health care facility types, exposure category, gender or geographic region.

*HIV Infections *Outcome and Process Assessment (Health Care)/STATISTICS & NUMER DATA *Quality of Health Care/STATISTICS & NUMER DATA


Information in this article was accurate in January 30, 1997. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.