title: HIV quality performance measures in a large integrated health care system.
abstract: HIV quality performance measurements are critical to evaluating a care program's success in areas of testing, access to and retention in care, care processes and outcomes. Kaiser Permanente (KP) provides care to over 8 million Americans and over 19,000 HIV-infected adults. We undertook a quality performance measurement program to assess the care and outcomes for our HIV-positive patient population. We also examined HIV testing practices among our HIV-uninfected patients presenting with a sexually transmitted infection. Our metrics were extracted electronically (encompassing two time periods: July 1, 2005 through June 30, 2006 and the entire calendar year 2007) and did not require any manual data extraction, which was a primary objective of our strategy. For most individual care measures, improvement over time was noted, with 85% or more performance seen on some measures (accessing care and initiating antiretroviral therapy). Opportunities for improvement were identified on other measures, such as diagnosing HIV at an earlier stage of infection, and more consistent Pneumocystis jiroveci pneumonia prophylaxis. Over 90% of our patients on antiretroviral therapy had maximal viral control, along with high median antiretroviral medication adherence. Our results compare favorably to those of other organizations, with a KP HIV mortality rate less than 50% of the overall U.S. rate. These results have implications for improving our care process going forward, as well as for the new U.S. domestic HIV/AIDS Strategy.
authors.affiliation: HIV Initiative, Kaiser Permanente, Oakland, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Horberg
authors.forename: Leo
authors.initials: L
authors.lastname: Hurley
authors.forename: William
authors.initials: W
authors.lastname: Towner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gambatese
authors.forename: Daniel
authors.initials: D
authors.lastname: Klein
authors.forename: Diana
authors.initials: D
authors.lastname: Antoniskis
authors.forename: Winkler
authors.initials: W
authors.lastname: Weinberg
authors.forename: Peter
authors.initials: P
authors.lastname: Kadlecik
authors.forename: Carol
authors.initials: C
authors.lastname: Remmers
authors.forename: Robert
authors.initials: R
authors.lastname: Dobrinich
authors.forename: Charles
authors.initials: C
authors.lastname: Quesenberry
authors.forename: Michael
authors.initials: M
authors.lastname: Silverberg
authors.forename: Michael
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents