Skip to main content
SpringerLink
Log in

Quality-of-Care Indicators for HIV/AIDS

  • Review Article
  • Published:
Disease Management and Health Outcomes

Abstract

As care for HIV/AIDS becomes more concentrated within specific providers and organisations, it would be useful to have indicators to describe the quality of care. This paper reviews concepts related to quality of care, and practical issues including sampling and risk adjustment. Indicators can be collected using a combination of administrative, chart review and survey data to reflect clinical, patient and societal perspectives. We suggest that for adults with HIV/AIDS, indicators might include measures of health status and patient satisfaction, and essential care processes. Health status measures could include CD4+ T-lymphocyte count and HIV-RNA, progression to AIDS, symptom scores, health-related quality of life scores, patient utility and disability days. Essential care processes could include receipt of acceptable antiretroviral treatment, CD4+ and HIV-RNA monitoring, screening for opportunistic infections, prophylaxis against Pneumocystis carinii pneumonia, handling of symptoms and pneumococcal vaccination. For those at increased risk for HIV, potential indicators include screening for HIV risk behaviours and HIV testing. Data from indicators such as these could be used by individuals to select among providers, purchasers of care to select among health plans and payors to hold provider groups accountable. In addition, data could be used by groups of providers to improve the quality of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II

Similar content being viewed by others

References

  1. Palella Jr FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998; 338: 853–60

    Article  PubMed  Google Scholar 

  2. O’Neill JF. Paying for HIV/AIDS care at the turn of the century. Am J Manage Care 1999: 5: 1442

    Google Scholar 

  3. Bartlett JG. Human immunodeficiency virus/AIDS managed care network. Clin Infect Dis 1997; 25: 803–4

    Article  PubMed  CAS  Google Scholar 

  4. Karon JM, Rosenberg PS, McQuillan G, et al. Prevalence of HIV infection in the United States,1984 to 1992. JAMA 1996; 276: 126–31

    Article  PubMed  CAS  Google Scholar 

  5. Bozzette SA, Berry SH, Duan N, et al. The care of HIV-infected adults in the United States. HIV cost and services utilization study consortium. N Engl J Med 1998; 339: 1897–904

    Article  PubMed  CAS  Google Scholar 

  6. Brook RH. Managed care is not the problem, quality is. JAMA 1997; 278: 1612–4

    Article  PubMed  CAS  Google Scholar 

  7. Donabedian A. Explorations in quality assessment and monitoring. Ann Arbor (MI): Health Administration Press, 1980

    Google Scholar 

  8. Stoskopf CH, Richter DL, Ciesla JR, et al. Evaluation of South Carolina’s HIV/AIDS community long term care Medicaid waiver: cost comparison and patient satisfaction. J Health Hum Serv Adm 1996; 19: 79–98

    PubMed  CAS  Google Scholar 

  9. Aiken LH, Sloane DM, Lake ET. Satisfaction with inpatient acquired immunodeficiency syndrome care. A national comparison of dedicated and scattered-bed units. Med Care 1997; 35: 948–62

    Article  PubMed  CAS  Google Scholar 

  10. Croucher R, Robinson P, Zakrzewska JM, et al. Satisfaction with care of patients attending a dedicated dental clinic: comparisons between 1989 and 1994. Int J STD AIDS 1997; 8: 150–3

    Article  PubMed  CAS  Google Scholar 

  11. Katz MH, Marx R, Douglas Jr JM, et al. Insurance type and satisfaction with medical care among HIV-infected men. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 14: 35–43

    Article  PubMed  CAS  Google Scholar 

  12. Bennett CL, Garfinkle JB, Greenfield S, et al. The relation between hospital experience and in-hospital mortality for patients with AIDS-related PCP. JAMA 1989; 261: 2975–9

    Article  PubMed  CAS  Google Scholar 

  13. Kitahata MM, Koepsell TD, Deyo RA, et al. Physicians’ experience with the acquired immunodeficiency syndrome as a factor in patients’ survival. N Engl J Med 1996; 334: 701–6

    Article  PubMed  CAS  Google Scholar 

  14. Palenicek J, Graham NMH, Wu AW, et al. Poorer survival among AIDS patients enrolled in managed care organizations (MCOs) vs traditional indemnity insurance. New Orleans, LA: 36th ICAAC Meetings, 1996

    Google Scholar 

  15. NY State Department of Health AIDS Institute. Protocols for the primary care of HIV/AIDS in adults and adolescents. New York: NY State Department of Health, 1995

    Google Scholar 

  16. Agins BD, Young MT, Ellis WC, et al. A statewide program to evaluate the quality of care provided to persons with HIV infection. Jt Comm J Qual Improv 1995 Sep; 21(9): 439–56

    PubMed  CAS  Google Scholar 

  17. Bennett CL. Medical record abstraction form and guidelines for assessing quality of care for hospitalized patients with AIDS-related pneumocystis carinii pneumonia. Santa Monica (CA): RAND, N-3549-AHCPR, 1993

    Google Scholar 

  18. Bozzette SA, Asch S. Developing quality review criteria from standards of care for HIV disease: a framework. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 8 Suppl. 1: S45–52

    PubMed  Google Scholar 

  19. Marx R, Katz MH, Barreto AI, et al. Receipt of recommended medical care in HIV-infected and at-risk persons. J Gen Intern Med 1995; 10: 92–5

    Article  PubMed  CAS  Google Scholar 

  20. Gross PA, Kaplan JE, Phair JP, et al. Indicators for assessment of compliance with quality standards for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. Clin Infect Dis 1995; 21 Suppl. 1: S138–41

    Article  PubMed  Google Scholar 

  21. Gross PA, Asch S, Kitahata M, et al. Performance measures for guidelines on preventing opportunistic infections in HIV infected patients. Clin Infect Dis. In press

  22. Harris C, Nyquist RP, Avery SJ, et al. Quality assurance for HIV-related care. Qual Rev Bull 1989; 1: 25–30

    Google Scholar 

  23. Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and services utilization study. JAMA 1999; 281: 2305–15

    Article  PubMed  CAS  Google Scholar 

  24. Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med 1997; 126: 946–54

    PubMed  CAS  Google Scholar 

  25. Prevention and control of influenza. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Morb Mortal Wkly Rep 1992; 41: 1–17

    Google Scholar 

  26. Whalen CC, Antani M, Carey J, et al. An index of symptoms for infection with human immunodeficiency virus: reliability and validity. J Clin Epidemiol 1994; 47: 537–46

    Article  PubMed  CAS  Google Scholar 

  27. Revicki DA, Wu AW, Brown R. Changein clinical status, health status and health utility outcomes in HIV-infected patients. Med Care 1995; 33(4 Suppl.): AS173–AS82

    Google Scholar 

  28. Cleary PD, Fowler Jr FJ, Weissman J, et al. Health-related quality of life in persons with acquired immune deficiency syndrome. Med Care 1993; 31: 569–80

    Article  PubMed  CAS  Google Scholar 

  29. Berry SH, Bozzette SA, Hays RD, et al. Measuring patient reported health status and experience in advanced HIV disease: HIV-PARSE survey instrument. Santa Monica (CA): RAND, MR-342-NIAID/SDAC, 1991

    Google Scholar 

  30. Lenderking WR, Testa MA, Katzenstein D, et al. Measuring quality of life in early HIV disease: the modular approach. Qual Life Res 1997 Aug; 6(6): 515–30

    Article  PubMed  CAS  Google Scholar 

  31. Berry SH, Brown JA, Athey L, et al. HCSUS baseline patient questionnaire documentation. Santa Monica (CA): RAND, 1998 May. Report MR-1090-AHCDR, 1999

    Google Scholar 

  32. Stewart AL, Ware JE, editors. Measuring functioning and well-being. The medical outcomes study approach. Durham (NC): Duke University Press, 1992

  33. Wu AW, Rubin HR, Mathews WC, et al. A health status questionnaire using 30 items from the medical outcomes study: preliminary validation in persons with early HIV infection. Med Care 1991; 29: 786–98

    Article  PubMed  CAS  Google Scholar 

  34. Wu AW, Revicki DA, Jacobson D, et al. Evidence for reliability, validity and usefulness of the medical outcomes study HIV health survey (MOS-HIV). Qual Life Res 1997; 6: 481–93

    Article  PubMed  CAS  Google Scholar 

  35. Stewart AL, Hays RD, Ware Jr JE. The MOS short-form general health survey: reliability and validity in a patient population. Med Care 1988; 26: 724–35

    Article  PubMed  CAS  Google Scholar 

  36. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection. Med Care 1992; 30: 473–83

    Article  PubMed  Google Scholar 

  37. Wu AW, Hays RD, Kelly S, et al. Applications of the medical outcomes study health-related quality of life measures in HIV/AIDS. Qual Life Res 1997; 6; 531–54

    Article  PubMed  CAS  Google Scholar 

  38. Hays RD, Cunningham WE, Sherbourne C, et al. Health-related quality of life in people receiving care for HIV infection in the United States: results from the HIV cost and services utilization study. Am J Med. In press

  39. Katz S, Ford AB, Moskowitz RW, et al. Studies of the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914–9

    Article  PubMed  CAS  Google Scholar 

  40. Stanton D, Wu AW, Moore R, et al. Functional status of persons with HIV infection in an outpatient setting. J Acquir Immune Def Synd 1994; 7: 1050–6

    CAS  Google Scholar 

  41. Wilson IB, Cleary PD. Clinical predictors of functioning in persons with acquired immunodeficiency syndrome. Med Care 1996; 34: 610–23

    Article  PubMed  CAS  Google Scholar 

  42. Wilson IB, Cleary PD. Clinical predictors of declines in physical functioning in persons with AIDS: results of a longitudinal study. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16: 343–9

    Article  PubMed  CAS  Google Scholar 

  43. Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM, editor. Evaulation of chemotherapeutic agents. New York: Columbia University Press, 1947

    Google Scholar 

  44. Wu AW. Quality of life assessment in clinical research: application in diverse populations. Med Care. In press

  45. Folstein MF, Folstein SE, McHugh PR. ’Mini mental state’ a practical method for grading the cognitive states of patients for the clinician. J Psychiatr Res 1975; 12: 189–98

    Article  PubMed  CAS  Google Scholar 

  46. Jones BN, Teng EL, Folstein MF, et al. A new bedside test of cognitiion for patients with HIV infection. Ann Intern Med 1993; 119: 1001–4

    PubMed  CAS  Google Scholar 

  47. Tsevat J, Solzan JG, Kuntz KM, et al. Health values of patients infected with human immunodeficiency virus. Relationship to mental health and physical functioning. Med Care 1996; 34: 44–57

    Article  PubMed  CAS  Google Scholar 

  48. Euroqol Group. EuroQol — a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208

    Article  Google Scholar 

  49. Wu AW, Jacobson D, Berzon R, et al. The effect of mode of administration on medical outcomes study health ratings and EuroQoL Scores in AIDS. Qual Life Res 1997; 6: 3–10

    PubMed  CAS  Google Scholar 

  50. National Center for Health Statistics. Current estimates from the Health Interview Survey: United States, 1968. Washington, DC: National Center for Health Statistics, 1970. PHS Pub. No. 1000, Ser. 10, No. 63

    Google Scholar 

  51. Pizzi M. The model of human occupation and adults with HIV infection and AIDS. Am J Occup Ther 1990; 44: 257–64

    Article  PubMed  CAS  Google Scholar 

  52. Yelin EH, Greenblatt RM, Hollander H, et al. The impact of HIV-related illness on employment. Am J Public Health 1991; 81: 79–84

    Article  PubMed  CAS  Google Scholar 

  53. Metz S, Fox R, Odaka N, et al. Employment status of men diagnoses with AIDS in the Baltimore MACS [abstract no. S.D.813]. Int Conf AIDS 1990; 6: 293

    Google Scholar 

  54. Kort R, Zamprelli J. Labour force participation for people living with HIV [abstract no. 60378]. Int Conf AIDS 1998; 12: 1069

    Google Scholar 

  55. Cleary PD, Fahs MC, Fulop W, et al. Using patient reports to assess hospital treatment of persons with AIDS: a pilot study. AIDS Care 1992; 4: 325–32

    Article  PubMed  CAS  Google Scholar 

  56. Cunningham WE, Hays RD, Ettl MK, et al. The prospective effect of access to medical care on health-related quality of life outcomes in patients with symptomatic HIV disease. Med Care 1998; 36: 295–306

    Article  PubMed  CAS  Google Scholar 

  57. Cunningham WE, Hays RD, Williams KW, et al. Access to medical care and health related quality of life for low-income persons with symptomatic human immunodeficieny virus. Med Care 1995; 33: 739–54

    Article  PubMed  CAS  Google Scholar 

  58. Bartlett JG. Human immunodeficiency virus/AIDS Medicaid managed care network. Clin Infect Dis 1997; 25: 803–4

    Article  PubMed  CAS  Google Scholar 

  59. Hays RD, Shaul JA, Williams VS, et al. Psychometric properties of the CAHPS 1.0 survey measures. Consumer assessment of health plans study. Med Care 1999; 37 Suppl. 3: MS22–31

    Article  PubMed  CAS  Google Scholar 

  60. Gifford AL, Laurent DD, Gonzalez VM, et al. A pilot randomized trial of education to improve self-management skills of men with symptomatic HIV/AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. In press

  61. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36(4): 439–46

    Article  PubMed  CAS  Google Scholar 

  62. Clark NM, Janz NK, Dodge JA, et al. Self-regulation of health behavior: the ‘take PRIDE’program. Health Educ Q 1992; 19(3): 341–54

    Article  PubMed  CAS  Google Scholar 

  63. Gonzalez VM, Goeppinger J, Lorig K. Four psychosocial theories and their application to patient education and clinical practice. Arthritis Care Res 1990; 3(3): 132–43

    PubMed  CAS  Google Scholar 

  64. Shively M, Gifford A, Bormann J, et al. Development of an HIV self-efficacy instrument [abstract]. Ann Behav Med 1998; 20: C121

    Google Scholar 

  65. US Department of Health and Human Services. HIV counseling, testing, and referral standards and guidelines. Washington, DC: US Department of Health and Human Services, May 1994

    Google Scholar 

  66. Malin J, Asch S, Kerr E, et al. Evaluating the quality of cancer care: development of cancer quality indicators for a global quality tool. Cancer 2000; 88: 701–7

    Article  PubMed  CAS  Google Scholar 

  67. CDC Public Health Services Task Force. Recommendations for the use of antiretrovrial drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal transmission in the United States. MMWR Morbid Mortal Wkly Rep 1998; 47 (RR-2)

  68. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331: 1173–80

    Article  PubMed  CAS  Google Scholar 

  69. Department of Health and Human Services, Henry J. Kaiser Family Foundation. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. Ann Intern Med 1998; 128: 1079–100

    Google Scholar 

  70. Carpenter CC, Cooper DA, Fischl MA, et al. Antiretroviral therapy in adults: updated recommendations of the International AIDS Society-USA Panel. JAMA 2000; 283: 381–90

    Article  PubMed  CAS  Google Scholar 

  71. Montaner JS, Reiss P, Cooper D, et al. A randomized, doubleblind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients: the INCAS Trial. Italy, The Netherlands, Canada and Australia Study [see comments]. JAMA 1998; 279: 930–7

    Article  PubMed  CAS  Google Scholar 

  72. Haubrich RH, Little SJ, Currier JS, et al. The value of patient-reported adherence to antiretroviral therapy in predicting vi-rologic and immunologic response. California Collaborative Treatment Group. AIDS 1999; 13: 1099–107

    Article  PubMed  CAS  Google Scholar 

  73. Cheever L, Wu AW. Adherence to antiretroviral therapies. Curr Infect Dis Rep 1999: 1(5): 401–7

    Article  PubMed  Google Scholar 

  74. US Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA). 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep 1999 Aug 20; 48(RR-10): 1–59, 61–6

    Google Scholar 

  75. Ellerbrock TV, Chiasson MA, Bush TJ, et al. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. JAMA 2000; 283: 1031–7

    Article  PubMed  CAS  Google Scholar 

  76. Halsey NA, Coberly JS, Desormeaux J, et al. Randomised trial of isoniazid versus rifampicin and pyrazinamide for prevention of tuberculosis in HIV-1 infection. Lancet 1998; 351: 786–92

    Article  PubMed  CAS  Google Scholar 

  77. Wilson IB, Cleary PD. Linking clinical variables with health related quality of life. A conceptual model of patient outcomes. JAMA 1995; 273: 590–65

    Google Scholar 

  78. Pincus T, Esther R, DeWalt DA, et al. Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med 1998; 129: 406–11

    PubMed  CAS  Google Scholar 

  79. Justice AC, Feinstein AR, Wells CK. A new prognostic staging system for the acquired immunodeficiency syndrome [see comments]. N Engl J Med 1989; 320: 1388–93

    Article  PubMed  CAS  Google Scholar 

  80. Justice AC, Aiken LH, Smith HL, et al. The role of functional status in predicting inpatient mortality with AIDS. J Clin Epidemiol 1996; 49: 193–201

    Article  PubMed  CAS  Google Scholar 

  81. Rabeneck L, Hartigan PM, Huang IW, et al. Predicting outcomes in HIV-infected veterans: I. Progression to AIDS. J Clin Epidemiol 1997; 50: 1231–40

    Article  PubMed  CAS  Google Scholar 

  82. Rabeneck L, Hartigan PM, Huang IW, et al. Predicting outcomes in HIV-infected veterans: II. Survival after AIDS. J Clin Epidemiol 1997; 50: 1241–8

    Article  PubMed  CAS  Google Scholar 

  83. Charlson ME, Pompei P, Ales KL, et al. Anew method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–83

    Article  PubMed  CAS  Google Scholar 

  84. Welch K, Kissinger P, Bessinger R, et al. The clinical profile of end-stage AIDS. AIDS Patient Care STDS. 1998; 12: 125–9

    Article  PubMed  CAS  Google Scholar 

  85. Shapiro MF, Berk ML, Berry SH, et al. National probability samples in studies of low-prevalence diseases. Part I: perspectives and lessons from the HIV cost and services utilization study. Health Serv Res 1999; 34: 951–68

    PubMed  CAS  Google Scholar 

  86. Frankel MR, Shapiro MF, Duan N, et al. National probability samples in studies of low-prevalence diseases. Part II: designing and implementing the HIV cost and services utilization study sample. Health Serv Res 1999; 34: 969–92

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Dr Asch’s time was supported by a VA Health Services Research and Development Career Development Award. Supported by the Managed Healthcare Association Outcomes Management System Project Consortium.

Author information

Authors and Affiliations

  1. Departments of Health Policy and Management, and Epidemiology, School of Hygiene and Public Health and the Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA

    Albert W. Wu (Associate Professor)

  2. The University of California San Diego, San Diego, California, USA

    Allen Gifford & Samuel A. Bozzette

  3. The RAND Corporation, Santa Monica, California, USA

    Allen Gifford, Steven Asch & Samuel A. Bozzette

  4. VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

    Steven Asch

  5. The University of California Los Angeles, Los Angeles, California, USA

    Steven Asch

  6. University of Rochester Medical Center, Rochester, New York, USA

    Susan E. Cohn

  7. The Foundation for Accountability, Portland, Oregon, USA

    Robin Yurk

Authors
  1. Albert W. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allen Gifford
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven Asch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan E. Cohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Samuel A. Bozzette
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robin Yurk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Albert W. Wu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wu, A.W., Gifford, A., Asch, S. et al. Quality-of-Care Indicators for HIV/AIDS. Dis-Manage-Health-Outcomes 7, 315–330 (2000). https://doi.org/10.2165/00115677-200007060-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200007060-00003

Keywords

Search

Navigation