Organization and management of care for military veterans with human immunodeficiency virus/acquired immunodeficiency syndrome in Department of Veterans Affairs Medical Centers.
OBJECTIVE
As the largest provider of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome health care services, the Department of Veterans Affairs (VA) has launched a national quality improvement program. As a first step, an assessment of how care for veterans with HIV/acquired immunodeficiency syndrome was organized was conducted.


METHODS
Structured surveys were administered to senior HIV clinicians in 118 VA facilities, about local approaches to structuring, staffing, and delivering HIV health services.


RESULTS
HIV care was chiefly delivered in special VA-based HIV clinics. HIV-related services were widely available on site, with non-VA referrals being more commonly needed to meet long-term care needs. Urban VA facilities had greater HIV caseloads, were more likely to have separate HIV clinics, and had greater access to HIV expertise, whereas rural practices focused on primary care-based models and tended to rely on off-site VA HIV experts.


CONCLUSIONS
Understanding the organization and management of VA-based HIV services will help design systematic quality improvement efforts and meet the treatment needs of HIV-infected veterans.
Yano
Elizabeth M
EM
Center for the Study of Healthcare Provider Behavior, Veterans Affairs Greater Los Angeles Health Services Research and Development Center of Excellence, Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda, CA 91343, USA.
Asch
Steven M
SM
Phillips
Barbara
B
Anaya
Henry
H
Bowman
Candice
C
Chang
Sophia
S
Bozzette
Samuel
S
D003625:Data Collection; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D010346:Patient Care Management / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans