Assessing the Quality of Human Immunodeficiency Virus Care in Nursing Homes.
Antiviral Agents
/ therapeutic use
CD4 Lymphocyte Count
/ statistics & numerical data
Cross-Sectional Studies
Female
HIV Infections
/ drug therapy
Humans
Insurance Claim Review
/ statistics & numerical data
Male
Medicare
/ statistics & numerical data
Middle Aged
Nursing Homes
/ statistics & numerical data
Pneumonia, Pneumocystis
/ prevention & control
Quality Indicators, Health Care
United States
/ epidemiology
Viral Load
/ statistics & numerical data
human immunodeficiency virus and aging
human immunodeficiency virus care quality Medicare Minimum Data Set
nursing homes
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
27
12
2019
revised:
10
01
2020
accepted:
13
01
2020
pubmed:
14
2
2020
medline:
3
3
2021
entrez:
14
2
2020
Statut:
ppublish
Résumé
Quality of human immunodeficiency virus (HIV) care in nursing homes (NHs) has never been measured. A cross-sectional study. NHs. A total of 203 NHs and 1375 persons living with HIV. Medicare claims from 2011 to 2013 were linked to assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Five nationally validated HIV care quality measures (prescription of antiretroviral therapy; CD4/viral load monitoring; frequency of medical visits; gaps in medical visits; and Pneumocystis pneumonia prophylaxis) were adapted and applied to NHs. Logistic regression predicted compliance by organizational factors. Random intercept logistic regression predicted if persons living with HIV received care by person and organizational factors. Compliance ranged from 43.3% (SD = 31.1%) for CD4/viral load monitoring to 92.4% (SD = 13.6%) for gaps in medical visits. More substantiated complaints against an NH decreased the likelihood of high compliance with CD4/viral load monitoring (odds ratio [OR] = 0.846; 95% confidence interval [CI] = 0.726-0.986), while NH-reported incidents increased the likelihood of high compliance with pneumocystis pneumonia prophylaxis (OR = 1.173; 95% CI = 1.044-1.317). Differences between NHs explained 21.2% or less of variability in receipt of care. Since 2013, the population with HIV and NH HIV care quality has inevitably evolved; however, this study provides previously unknown baseline metrics on NH HIV care quality and highlights significant challenges when measuring HIV care in NHs. J Am Geriatr Soc 68:1226-1234, 2020.
Sections du résumé
BACKGROUND
Quality of human immunodeficiency virus (HIV) care in nursing homes (NHs) has never been measured.
DESIGN
A cross-sectional study.
SETTING
NHs.
PARTICIPANTS
A total of 203 NHs and 1375 persons living with HIV.
MEASUREMENTS
Medicare claims from 2011 to 2013 were linked to assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Five nationally validated HIV care quality measures (prescription of antiretroviral therapy; CD4/viral load monitoring; frequency of medical visits; gaps in medical visits; and Pneumocystis pneumonia prophylaxis) were adapted and applied to NHs. Logistic regression predicted compliance by organizational factors. Random intercept logistic regression predicted if persons living with HIV received care by person and organizational factors.
RESULTS
Compliance ranged from 43.3% (SD = 31.1%) for CD4/viral load monitoring to 92.4% (SD = 13.6%) for gaps in medical visits. More substantiated complaints against an NH decreased the likelihood of high compliance with CD4/viral load monitoring (odds ratio [OR] = 0.846; 95% confidence interval [CI] = 0.726-0.986), while NH-reported incidents increased the likelihood of high compliance with pneumocystis pneumonia prophylaxis (OR = 1.173; 95% CI = 1.044-1.317). Differences between NHs explained 21.2% or less of variability in receipt of care.
CONCLUSIONS
Since 2013, the population with HIV and NH HIV care quality has inevitably evolved; however, this study provides previously unknown baseline metrics on NH HIV care quality and highlights significant challenges when measuring HIV care in NHs. J Am Geriatr Soc 68:1226-1234, 2020.
Identifiants
pubmed: 32052860
doi: 10.1111/jgs.16359
pmc: PMC8111571
mid: NIHMS1683644
doi:
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1226-1234Subventions
Organisme : AHRQ HHS
ID : R36HS025662
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG046341
Pays : United States
Organisme : NIA NIH HHS
ID : T32 AG023480
Pays : United States
Organisme : AHRQ HHS
ID : R36 HS025662
Pays : United States
Organisme : NIA NIH HHS
ID : R01AG04634101A1
Pays : United States
Organisme : NIA NIH HHS
ID : R21 AG049269
Pays : United States
Organisme : NIA NIH HHS
ID : R21AG049269
Pays : United States
Informations de copyright
© 2020 The American Geriatrics Society.
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