Quality of Care (QOC) in the first twelve months after entry of HIV CARE is associated with a higher mortality risk, according to US Department of Veterans Affairs in the online edition report of Clinic Infectious Diseases. Patients who received at least 80% of the recommended quality indicators (IQs) had 25% less likely to die during the follow-up period when compared to patients receiving less than 80% of IQs. Good results have been observed in patients with alcohol problems or drugs who have received high levels of care.
"The current study finds that HIV-infected patients receiving high QOC experience the highest mortality," the authors write. "High quality care provided by healthcare systems and providers can translate into decreased mortality for patients."
But a good quality of care was unable to overcome the mortality deficits associated with disease severity and comorbidities.
On the other hand, the author of an editorial suggests that quality of care and indicators may require changes in order to keep pace with the ever-increasing medical needs associated with HIV infection.
US health care providers are encouraged to report on the quality of care measures through reports. Although quality of care and indicators of HIV infection are well established, the relationship between care indicators and the subsequent mortality risk has not been well described. But more importantly, it is not known whether good quality of care can outweigh the increased risk of mortality seen in HIV-infected patients with medications and / or alcohol problems.
To answer these questions, investigations in the cohort study of the Veterans' Aging cohort developed in a comparative study of mortality risk in HIV-positive patients based on the quality of care provided in the first twelve months after entry into the HIV CARE.
Patients who entered between 2002 and 2008 were recruited for the study. Nine quality care indicators were assessed:
- Reception of antiretroviral therapy (ART).
- Prophylaxis against pneumocystosis is justified by the low CD4 count.
- Prophylaxis against MAC (Mycobacterium Avyum Complex) is justified by the low CD4 count.
- Vaccination against pneumococcus.
- Annual flu vaccine.
- Periodic testing for blood lipids.
- Continuous monitoring for hepatitis C virus (HCV) co-infections.
- Appropriate clinic for HIV treatment.
- Monitoring the CD4 count.
Data were also collected from drug, alcohol, and comorbid use.
. Patients were followed up to 2014.
The researchers compared the risk of mortality among individuals who received 80% or more of the quality of care indicators in the first twelve months of care and individuals who did not receive this standard of care.
A total of 3038 patients were recruited for the study. Most are male (98%) and black (67%). Middle Ages the subscription was 49 years. Alcohol abuse was present in 28% of patients and 26% reported use of psychotropic substance; 11% reported drug and alcohol problems.
The patients were followed up for an average of eight years. There were 902 deaths (30% of the cohort) during 24805 people-years of follow-up.
About 70% of the patients received 80% or more of the care indicators in the first year.
Overall, receiving 80% or more of the recommended care indicators was associated with a reduction of 25% in mortality risk compared to lower standards of care (adjusted for age 0,75 risk ratio, 95% IC, 0,65-0,86 ). The association between higher quality of care and lower risk of mortality was independent of drugs or alcohol abuse. However, quality of care was unable to overcome the higher risk of mortality associated with disease severity (adjusted for age risk ratio 1,18, IC 95%, 1.15 -1.21).
"The year 2010 US National HIV / AIDS Strategy identifies QOC [quality of care] improvement for people living with HIV as a national priority," the authors conclude.
"The current study suggests that this policy may further improve survival among HIV-infected patients who are caring but that increasing adherence to quality of care measured may not be sufficient to improve mortality levels without addressing underlying conditions . "
The editorial describes the lower mortality associated with quality health care soon after entering HIV CARE as "commendable." But the author notes:
The results "do not provide an indication of sustained quality of care." In addition, because HIV has become chronic, throughout life, for most patients it is no longer adequate to monitor results based exclusively on care during first year of follow-up. The author writes: "Our indicators of quality of care will have to change."
Posted in: 28 2015 September
Korthuis PT et al. Quality of HIV care and mortality in HIV-infected patients. Clin infecting Dis, editing online, up to 2015.
Horberg MA. HIV Measures Quality and Results - The Next Phase . Clin infec Dis, online edition, 2015