Quality of HIV Care and Mortality Rates in HIV-Infected Patients.
BACKGROUND
The Patient Protection and Affordable Care Act encourages healthcare systems to track quality-of-care measures; little is known about their impact on mortality rates. The objective of this study was to assess associations between HIV quality of care and mortality rates.


METHODS
A longitudinal survival analysis of the Veterans Aging Cohort Study included 3038 human immunodeficiency virus (HIV)-infected patients enrolled between June 2002 and July 2008. The independent variable was receipt of ≥80% of 9 HIV quality indicators (QIs) abstracted from medical records in the 12 months after enrollment. Overall mortality rates through 2014 were assessed from the Veterans Health Administration, Medicare, and Social Security National Death Index records. We assessed associations between receiving ≥80% of HIV QIs and mortality rates using Kaplan-Meier survival analysis and adjusted Cox proportional hazards models. Results were stratified by unhealthy alcohol and illicit drug use.


RESULTS
The majority of participants were male (97.5%) and black (66.8%), with a mean (standard deviation) age of 49.0 (8.8) years. Overall, 25.9% reported past-year unhealthy alcohol use and 28.4% reported past-year illicit drug use. During 24 805 person-years of follow-up (mean [standard deviation], 8.2 [3.3] years), those who received ≥80% of QIs experienced lower age-adjusted mortality rates (adjusted hazard ratio, 0.75; 95% confidence interval, .65-.86). Adjustment for disease severity attenuated the association.


CONCLUSIONS
Receipt of ≥80% of select HIV QIs is associated with improved survival in a sample of predominantly male, black, HIV-infected patients but was insufficient to overcome adjustment for disease severity. Interventions to ensure high-quality care and address underlying chronic illness may improve survival in HIV-infected patients.
Oregon Health & Science University, Portland.
Philip Todd
PT
Korthuis
VA Pittsburgh Healthcare System.
Kathleen A
KA
McGinnis
VA Pittsburgh Healthcare System.
Kevin L
KL
Kraemer
Center for Health Equity Research and Promotion.|Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania.
Adam J
AJ
Gordon
VA Pittsburgh Healthcare System.
Melissa
M
Skanderson
Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine.|Veterans Aging Cohort Study Coordinating Center.
Amy C
AC
Justice
The Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.
Stephen
S
Crystal
VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA.
Matthew Bidwell
MB
Goetz
VA Medical Center and George Washington University Medical Center, Washington D.C.
Cynthia L
CL
Gibert
VA Medical Center and Emory University School of Medicine, Atlanta, Georgia.
David
D
Rimland
Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine.
Lynn E
LE
Fiellin
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven.
Julie R
JR
Gaither
Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine.
Karen
K
Wang
VA Greater Palo Alto Healthcare System and Stanford University, California.
Steven M
SM
Asch
Boston University, Massachusetts.
Donald Keith
DK
McInnes
University of Iowa Carver College of Medicine, Iowa City.
Michael E
ME
Ohl
HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland.
Kendall
K
Bryant
Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine.|Veterans Aging Cohort Study Coordinating Center.
Janet P
JP
Tate
VA Connecticut Care System, West Haven, Connecticut.|Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Mona
M
Duggal
Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine.
David A
DA
Fiellin
D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011787:Quality of Health Care; D016019:Survival Analysis; D014728:Veterans
HIV; alcohol; health care; opioid-related disorders; quality of health care