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Symptom-based framework for assessing quality of HIV care
Steven M Asch1, Allen M Fremont, Barbara J Turner
1Department of General Internal Medicine, VA Greater Los Angeles Health System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA. sasch@rand.org
Summary
Quality indicators for human immunodeficiency virus (HIV) care revealed significant underuse of services for common symptoms. While care improved with advanced HIV disease, many patients still received suboptimal treatment, highlighting the need for symptom-based quality measures.
Area of Science:
- Infectious Diseases
- Public Health
- Health Services Research
Background:
- Quality of care for human immunodeficiency virus (HIV) infection is crucial for patient outcomes.
- Conventional quality measures may not fully capture the patient experience, particularly regarding symptom management.
- Symptom-based indicators offer a patient-centered approach to evaluating HIV care.
Purpose of the Study:
- To assess the quality of HIV care using a framework focused on patient-reported symptoms.
- To develop and apply quality indicators for common, burdensome HIV-related symptoms.
Main Methods:
- An expert panel defined 13 quality indicators for cough with fever/shortness of breath, severe diarrhea, and significant weight loss.
- A nationally representative sample of 2864 HIV-infected adults was interviewed regarding symptoms and care received.
- Adherence to indicators was analyzed based on symptom type, severity, and patient characteristics.
Main Results:
- Among 920 patients experiencing significant symptoms, only 41-74% received all indicated care.
- Care adherence was better for patients with advanced HIV (CD4 <50) compared to less severe disease (CD4 >500).
- Uninsured patients showed poorer quality of care compared to Medicare beneficiaries; CD4 count was the primary predictor.
Conclusions:
- Symptom-based quality indicators are a valuable supplement to traditional measures in HIV care.
- Significant underuse of services for common HIV symptoms was reported by patients.
- While care quality improved with disease severity, many patients with advanced HIV still received suboptimal care.