Quality of care (QOC) in the first twelve months after the entry of HIV CARE is associated with a higher mortality risk, according to researchers from theUS Department of Veterans Affairsin the online edition of the report Clinic Infectious Diseases. Patients who received at least 80% of the recommended quality indicators (IQ) had 25% less likely to die during the follow-up period than patients who received less than 80% of IQ. Good results were observed in patients with alcohol problems or medications that received high levels of care.
"The current study finds that HIV-infected patients receiving high QOC experience higher mortality," comment the authors. "High quality of care provided by health care providers and systems can translate into decreased mortality for patients."
But a good quality of care was unable to overcome the death deficits associated with disease severity and comorbidities.
On the other hand, the author of an editorial suggests that the quality of care, and the indicators may need to change in order to keep pace with the ever-increasing medical needs associated with HIV infection.
Health care providers in the US are encouraged to report, via reports on the quality of care measures. Although the quality of care and indicators of HIV infection is well established, the relationship between care indicators and the subsequent risk of mortality has not been well described. But more importantly, it is unclear whether the quality of care can overcome the greatest risk of mortality observed in HIV-infected patients with drugs and / or alcohol problems.
To answer these questions, the investigations in the cohort study cohort of aging veterans developed a comparative study of mortality risk in HIV-positive patients due to the quality of care in the first twelve months after entryHIV CARE.
Patients who entered between 2002 and 2008 were recruited for the study. Nine care quality indicators were assessed:
- Receipt of antiretroviral therapy (ART).
- The prophylaxis against pneumocystis is justified by the low CD4 count.
- Prophylaxis against MAC (mico Bacterium Avyum Complex) is justified by the low CD4 count.
- Pneumococcal vaccination.
- Annual flu shot.
- Periodic testing for blood lipids.
- Continuous monitoring for hepatitis C virus (HCV) co-infection.
- Clinical suitable for the treatment of HIV.
- Monitoring CD4 count.
Data were also collected from drug use, and comorbid alcohol.
. Patients were followed up to 2014.
The researchers compared the risk of death among individuals who received 80% or more of the quality of care indicators in the first twelve months of care and individuals who do not get this standard of care.
A total of 3038 patients were recruited for the study. Most are male (98%) and blacks (67%). Middle Ages registration was 49 years. Alcohol abuse was present in 28% of patients and 26% reported using psychotropic substance; 11% reported problems of drugs and alcohol.
Patients were followed for an average of eight years. There was 902 deaths (30% of the cohort) during 24805 person-years of follow-up.
About 70% of patients received 80% or more of care indicators in the first year.
In general, receiving 80% or more indicators of recommended care was associated with a reduction 25% risk of mortality compared with lower standards of care (adjusted for age risk ratio 0,75 CI 95% 0,65 -0,86 ). The association between higher quality care and lower mortality risk was independent of drug or alcohol abuse. However, the quality of care was unable to overcome the increased risk of mortality associated with disease severity (adjusted for age reason 1,18 risk; CI% 95, 1.15 -1.21).
"The year 2010 US National HIV / AIDS Strategy identifies improving QOC [quality of service] for people living with HIV as a national priority," the authors conclude.
"The study current suggests that this policy can still improve survival among HIV-infected patients who are dedicated to take care of, but that increased adherence to quality of care measurement may not be sufficient to improve the levels of mortality without facing conditions underlying . "
The editorial describes the lower mortality associated with quality health care soon after entering HIV CARE as "commendable." But the author notes:
The "non provide a sustained careful quality indication." Moreover, because HIV has become chronic, throughout life, for most patients no longer suitable for monitoring based exclusively results in the care during the first year of follow-up. The author writes: "Our indicators of quality of care will have to change."
Published: 28 September 2015
EN Korthuis et al.Quality HIV care and mortality in HIV-infected patients. Clin infect Dis, online edition, up to 2015.
Horberg MA.HIV quality measures and outcomes - the next phase. Clin infect Dis, online edition, 2015