Quality of HIV Care and Mortality Rates in HIV-Infected Patients

Philip Todd Korthuis; Kathleen A McGinnis; Kevin L Kraemer; Adam J Gordon; Melissa Skanderson; Amy C Justice; Stephen Crystal; Matthew Bidwell Goetz; Cynthia L Gibert; David Rimland; Lynn E Fiellin; Julie R Gaither; Karen Wang; Steven M Asch; Donald Keith McInnes; Michael E Ohl; Kendall Bryant; Janet P Tate; Mona Duggal; David A Fiellin; Veterans Aging Cohort Study

doi:10.1093/cid/civ762

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Quality of HIV Care and Mortality Rates in HIV-Infected Patients

Journal article

Open access

Peer reviewed

Quality of HIV Care and Mortality Rates in HIV-Infected Patients

Philip Todd Korthuis, Kathleen A McGinnis, Kevin L Kraemer, Adam J Gordon, Melissa Skanderson, Amy C Justice, Stephen Crystal, Matthew Bidwell Goetz, Cynthia L Gibert, David Rimland, …

Clinical infectious diseases, Vol.62(2), pp.233-239

01/15/2016

DOI: 10.1093/cid/civ762

PMCID: PMC4690479

PMID: 26338783

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Abstract

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. 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. 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. 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.

Veterans

Humans

Middle Aged

Mortality

Survival Analysis

Female

HIV Infections - mortality

Male

Longitudinal Studies

Quality of Health Care

Details

Title: Subtitle: Quality of HIV Care and Mortality Rates in HIV-Infected Patients
Creators: Philip Todd Korthuis - Oregon Health & Science University, Portland
Kathleen A McGinnis - VA Pittsburgh Healthcare System
Kevin L Kraemer - VA Pittsburgh Healthcare System
Adam J Gordon - Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania
Melissa Skanderson - VA Pittsburgh Healthcare System
Amy C Justice - Veterans Aging Cohort Study Coordinating Center
Stephen Crystal - The Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
Matthew Bidwell Goetz - VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA
Cynthia L Gibert - VA Medical Center and George Washington University Medical Center, Washington D.C
David Rimland - VA Medical Center and Emory University School of Medicine, Atlanta, Georgia
Lynn E Fiellin - Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine
Julie R Gaither - Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven
Karen Wang - Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine
Steven M Asch - VA Greater Palo Alto Healthcare System and Stanford University, California
Donald Keith McInnes - Boston University, Massachusetts
Michael E Ohl - University of Iowa Carver College of Medicine, Iowa City
Kendall Bryant - HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
Janet P Tate - Veterans Aging Cohort Study Coordinating Center
Mona Duggal - Post Graduate Institute of Medical Education and Research, Chandigarh, India
David A Fiellin - Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine
Veterans Aging Cohort Study
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.62(2), pp.233-239
DOI: 10.1093/cid/civ762
PMID: 26338783
PMCID: PMC4690479
ISSN: 1058-4838
eISSN: 1537-6591
Grant note: U24 AA022001 / NIAAA NIH HHS U24-AA020794 / NIAAA NIH HHS U24 AA020794 / NIAAA NIH HHS U01 AA020790 / NIAAA NIH HHS K23 DA019809 / NIDA NIH HHS R01-AA022886 / NIAAA NIH HHS R01 AA022886 / NIAAA NIH HHS U01-AA020790 / NIAAA NIH HHS
Language: English
Date published: 01/15/2016
Academic Unit: Psychiatry; Internal Medicine
Record Identifier: 9984094506302771

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