Uniform, national measures should define HIV/AIDS care

To improve the quality of HIV care and treatment nationwide, 17 measures such as screening and prevention for infections and monitoring of antiretroviral therapy should be adopted uniformly, according a work group led by a Kaiser Permanente researcher.

The work group's study results appear in the current issue of Clinical Infectious Diseases.

The study shows how national HIV quality performance measures were developed, approved by national bodies, and are being implemented, said Michael Horberg, MD, MAS, FACP, director of HIV/AIDS for Kaiser Permanente, a research scientist at the Kaiser Permanente Division of Research, and the lead author of the study. Horberg was one of two co-chairs who led the effort and determined the measures to be included and their specifications. Kaiser Permanente is the largest private provider of HIV care in the United States.

The measures assess a wide range of care, including patient retention, screening and prevention for infections, immunization, and initiation and monitoring of antiretroviral therapy. The measures are being pilot tested and have been endorsed by the National Quality Forum, National Committee For Quality Assurance, American Medical Association, the HIV Medical Association, Infectious Disease Society of America, and Health Resources and Service Administration (Health & Human Services). "Taken together, these measures represent the most important aspects of HIV care that impact the greatest number of HIV-infected individuals in the Unites States today," Horberg said.

"HIV disease has become a complex, chronic condition. Measurement of quality of care is an essential component of successful therapy," Horberg added. "And once those measurements are made, it's important that they be used to create quality improvement programs that set and create expectations for a certain level of quality care."

Many of the measures outlined by the work group already are in place at Kaiser Permanente, which is the largest private provider of HIV care in the United States and has a large HIV registry of 17,000+ patients that's enabled Kaiser Permanente to improve its HIV management so that the mortality rate for Kaiser Permanente HIV patients is half the national average.

As noted in the study, the measures do not reflect all aspects of HIV care. Most measures related to pregnancy processes and outcomes are not included. Pediatric measures are similarly not present, although the HRSA's HIV-AIDS Bureau is developing a set of those measures.