Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

Daria Podlekareva; Joanne Reekie; Amanda Mocroft; Marcelo Losso; Aza G Rakhmanova; Elzbieta Bakowska; Igor A Karpov; Jeff Lazarus; Jose Gatell; Jens Lundgren; Ole Kirk

doi:10.1186/1471-2334-12-229

Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

Daria Podlekareva, Joanne Reekie, Amanda Mocroft, Marcelo Losso, Aza G Rakhmanova, Elzbieta Bakowska, Igor A Karpov, Jeff Lazarus, Jose Gatell, Jens Lundgren, Ole Kirk

9 Citationer (Scopus)

Abstract

Background: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.Methods: Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART).Results: 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm³ were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively).Conclusions: This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.

Originalsprog	Engelsk
Tidsskrift	B M C Infectious Diseases
Vol/bind	12
Sider (fra-til)	229
Antal sider	1
ISSN	1471-2334
DOI	https://doi.org/10.1186/1471-2334-12-229
Status	Udgivet - 25 sep. 2012

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10.1186/1471-2334-12-229

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title = "Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study",

abstract = "Background: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.Methods: Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART).Results: 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively).Conclusions: This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.",

author = "Daria Podlekareva and Joanne Reekie and Amanda Mocroft and Marcelo Losso and Rakhmanova, {Aza G} and Elzbieta Bakowska and Karpov, {Igor A} and Jeff Lazarus and Jose Gatell and Jens Lundgren and Ole Kirk",

year = "2012",

month = sep,

day = "25",

doi = "10.1186/1471-2334-12-229",

language = "English",

volume = "12",

pages = "229",

journal = "B M C Infectious Diseases",

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TY - JOUR

T1 - Benchmarking HIV health care

T2 - from individual patient care to health care evaluation. An example from the EuroSIDA study

AU - Podlekareva, Daria

AU - Reekie, Joanne

AU - Mocroft, Amanda

AU - Losso, Marcelo

AU - Rakhmanova, Aza G

AU - Bakowska, Elzbieta

AU - Karpov, Igor A

AU - Lazarus, Jeff

AU - Gatell, Jose

AU - Lundgren, Jens

AU - Kirk, Ole

PY - 2012/9/25

Y1 - 2012/9/25

N2 - Background: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.Methods: Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART).Results: 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively).Conclusions: This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.

AB - Background: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.Methods: Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART).Results: 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively).Conclusions: This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.

U2 - 10.1186/1471-2334-12-229

DO - 10.1186/1471-2334-12-229

M3 - Journal article

C2 - 23009317

SN - 1471-2334

VL - 12

SP - 229

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

ER -

Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

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