Methods: Using 2013 national VA data, we identified 21,334 Veterans receiving care for HIV infection in a single infectious disease specialty clinic. For each clinic, we calculated risk-adjusted rates of viral control, HTN control (i.e. proportion of Veterans with HIV and HTN diagnoses with last blood pressure ‹ 140/90mmHg), and DM control (i.e. proportion of Veterans with HIV and DM diagnoses with last hemoglobin A1C ‹ 9%). For each measure, we limited analyses to clinics with ≥ 25 eligible Veterans (N=109 clinics for viral control, 75 clinics for HTN control, and 42 clinics for DM control). Clinic rates were risk-adjusted for characteristics of Veterans in care (i.e. “case-mix”), including demographics, other comorbidities, CD4 cell count nadir, residential ZIP-code poverty rates from census data, and time in HIV care.
Results: HIV clinics varied substantially in their rates of viral control (range 77.9% to 95.1%), HTN control (range 64%% to 73.0%), and DM control (range 78.7% to 91.1%). However, there was little correlation between these rates at the clinic level (Pearson correlation coefficient 0.11 between viral control and HTN control, 0.01 between viral control and DM control, and 0.05 between HTN and DM control).
Conclusion: We found substantial variation in rates of viral control, HTN control, and DM control between HIV clinics, but these rates were not highly correlated at the clinic level. HIV clinics that were high-performing for viral control were often not high-performing for comorbidity control. Quality improvement initiatives in HIV clinics should be undertaken with the awareness that improvements in quality measures for one domain of care may not be associated with improvements in measures for other domains of care.
V. Parker, None
H. Swan, None
D. Mcinnes, None
V. Yakovchenko, None
A. Midboe, None
B. Bokhour, None
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