title: Pediatric HIVQUAL-T: measuring and improving the quality of pediatric HIV care in Thailand, 2005-2007.
abstract: BACKGROUND
  As increasing numbers of children initiate antiretroviral treatment (ART), a systematic process is needed to measure and improve pediatric HIV care quality.
  
  
  METHODS
  Pediatric HIVQUAL-T, a model for performance measurement and quality improvement (QI), was adapted from the U.S. HIVQUAL model by incorporating Thai national guidelines as standards. In each of five pilot-site hospitals in Thailand in 2005-2007, clinical data abstracted from patient records were used to identify priority areas for QI. Improvement strategies were designed by clinic teams in different care system areas, and indicators were remeasured in 2006 and 2007.
  
  
  RESULTS
  At the five hospitals, 1119 HIV-infected children younger than 15 years of age received care in 2005, 1183 in 2006, and 1,341 in 2007--of whom 460, 435, and 418, respectively, were selected for chart abstraction. Of the eligible children, > or = 95% received clinical monitoring, annual CD4 count monitoring, ART, and adherence and growth assessments; 60%-90% received Pneumocystis jiroveci pneumonia (PCP) prophylaxis, tuberculosis (TB) screening, oral health assessments, and HIV disclosure. Indicators with a score < or = 40% in 2005 but with significant improvement (p < .05) in 2006-2007 following QI activities were Mycobacterium avium complex (MAC) prophylaxis, and cytomegalovirus (CMV) retinitis and immunization screenings.
  
  
  CONCLUSIONS
  Despite the promulgation of national guidelines, performance rates of some pediatric HIV indicators needed improvement. The pediatric HIVQUAL-T model facilitates use of hospital data for pediatric HIV care improvement and indicates that the U.S. HIVQUAL model is adaptable to developing countries.
authors.affiliation: Preventing-Mother-to-Child HIV Transmission and Pediatrics, Global AIDS Program Asia Regional Office, Thailand Ministry of Public Health-U.S. Centers for Disease and Control and Prevention Collaboration, Nonthaburi, Thailand. rangsimaL@th.cdc.gov
authors.forename: Rangsima
authors.initials: R
authors.lastname: Lolekha
authors.forename: Suchin
authors.initials: S
authors.lastname: Chunwimaleung
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.forename: Pimsiri
authors.initials: P
authors.lastname: Leawsrisook
authors.forename: Wasana
authors.initials: W
authors.lastname: Prasitsuebsai
authors.forename: Pramot
authors.initials: P
authors.lastname: Srisamang
authors.forename: Jurai
authors.initials: J
authors.lastname: Wongsawat
authors.forename: Worawan
authors.initials: W
authors.lastname: Faikratok
authors.forename: Sarika
authors.initials: S
authors.lastname: Pattanasin
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Agins
authors.forename: Kimberley K
authors.initials: KK
authors.lastname: Fox
authors.forename: Michelle S
authors.initials: MS
authors.lastname: McConnell
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000628:therapy*; D006739:Hospital Administration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007256:Information Systems / Q000458:organization & administration; D017064:Process Assessment, Health Care / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D013785:Thailand
chemical_list: D044966:Anti-Retroviral Agents