title: The HIV Workforce in New York State: Does Patient Volume Correlate with Quality?
abstract: BACKGROUND
  Knowledge of care practices among clinicians who annually treat <20 human immunodeficiency virus (HIV)-positive patients with antiretroviral therapy (ART) is insufficient, despite their number, which is likely to increase given shifting healthcare policies. We analyze the practices, distribution and quality of care provided by low-volume prescribers (LVPs) based on available data sources in New York State.
  
  
  METHODS
  We communicated with 1278 (66%) of the LVPs identified through a statewide claims database to determine the circumstances under which they prescribed ART in federal fiscal year 2009. We reviewed patient records from 84 LVPs who prescribed ART routinely and compared their performance with that of experienced clinicians practicing in established HIV programs.
  
  
  RESULTS
  Of the surveyed LVPs, 368 (29%) provided routine ambulatory care for 2323 persons living with HIV/AIDS, and 910 LVPs cited other reasons for prescribing ART. Although the majority of LVPs (73%) practiced in New York City, patients living upstate were more likely to be cared for by a LVP (odds ratio, 1.7; 95% confidence interval, 1.4-1.9). Scores for basic HIV performance measures, including viral suppression, were significantly higher in established HIV programs than for providers who wrote prescriptions for <20 persons living with HIV/AIDS (P < .01). We estimate that 33% of New York State clinicians who provide ambulatory HIV care are LVPs.
  
  
  CONCLUSIONS
  Our findings suggest that the quality of care associated with providers who prescribe ART for <20 patients is lower than that provided by more experienced providers. Access to experienced providers as defined by patient volume is an important determinant of delivering high-quality care and should guide HIV workforce policy decisions.
authors.affiliation: New York State Department of Health AIDS Institute.
authors.forename: Maeve
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: New York State Department of Health AIDS Institute.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Karelas
authors.affiliation: New York State Department of Health AIDS Institute.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feller
authors.affiliation: New York State Department of Health AIDS Institute.
authors.forename: Emily
authors.initials: E
authors.lastname: Knudsen-Strong
authors.affiliation: New York State Department of Health AIDS Institute.
authors.forename: Dawn
authors.initials: D
authors.lastname: Lajeunesse
authors.affiliation: New York State Department of Health AIDS Institute.
authors.forename: Dennis
authors.initials: D
authors.lastname: Tsui
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Columbia University, and New York Presbyterian Hospital, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Gordon
authors.affiliation: New York State Department of Health AIDS Institute.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Agins
mesh_terms: D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D009518:New York; D011361:Professional Competence; D011787:Quality of Health Care
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; antiretroviral therapy; patient volume; quality care; workforce