National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care HIV/AIDS core clinical performance measures are indicators for use in monitoring the quality of care provided to adults and adolescents living with HIV. Based on the set of quality measures developed by the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA), performance can be measured for various HIV prevention and treatment services. Services indicated for patients with HIV include: n Two or more CD4 cell counts performed in the measurement year. n HAART for patients with AIDS. n Two or more medical visits in an HIV care setting in the measurement year. n PCP prophylaxis for patients with CD4 cell count below 200. Chapter 2 HIV and AIDS Currently, national data on HIV care are not routinely collected. HIV measures tracked in the NHDR come from the HIV Research Network, which consists of 18 medical practices across the United States that treat large numbers of patients living with HIV. Data from the voluntary HIV Research Network are not nationally representative of the level of care received by everyone in the United States living with HIV. HIV Network data represent only patients with HIV who are actually receiving care (about 14,000 patients per year) and do not represent patients who do not receive care. Furthermore, data shown below are not representative of the HIV Research Network as a whole because they represent only a subset of network sites that have the best data. Below are data from the HIV Research Network that capture four of the recommended HRSA measures. In addition, when CD4 cell counts fall below 50, medicine to prevent development of disseminated MAC infection is routinely recommended (Yeargin, et al., 2003). 80 National Healthcare Disparities Report, 2011
Effectiveness of Care Figure 2.22. Adults with HIV who received recommended care, by race/ethnicity and gender, 2008 100 Total White Black Hispanic 100 Male Female 95 95 Percent 90 85 80 75 Z 0 2 or More Outpatient Visits 2 or More CD4 Tests HAART PCP MAC Percent 90 85 80 75 Z 0 2 or More Outpatient Visits 2 or More CD4 Tests HAART PCP MAC Chapter 2 HIV and AIDS Key: HAART = highly active antiretroviral therapy; PCP = Pneumocystis pneumonia; MAC = Mycobacterium avium complex. Source: Agency for Healthcare Research and Quality, HIV Research Network, 2008. Note: For HAART measure, adult HIV patients had to be enrolled in an HIV Network clinic, receive at least one CD4 test, and have at least one outpatient visit in addition to having at least one CD4 test result of 350 or less. n Overall, in 2008, nearly 90% of people with HIV had two or more outpatient visits during the year, and 83% of people with HIV had two or more CD4 tests during the year (Figure 2.22). In addition, 89% of people with HIV in care received HAART, 95% of people with HIV and CD4 count less than 200 received PCP prophylaxis, and 90% of people with HIV and CD4 count less than 50 received MAC prophylaxis. n In 2008, there were no statistically significant differences by race/ethnicity in the percentage of people with HIV receiving recommended services. n In 2008, the rate for people with HIV who had two or more CD4 tests during the year was lower than the rates for all other recommended services for HIV care, at approximately 83% for both males and females. n In 2008, there were no statistically significant gender differences in the percentage of people with HIV receiving recommended services. Also, in the NHQR: n In 2008, there were no statistically significant differences by age in the percentage of people with HIV receiving recommended services. National Healthcare Disparities Report, 2011 81
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U.S. Department of Health and Human
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