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The Department of Veterans Affairs' Experience

Lisa I. Backus, MD, PhD; Derek B. Boothroyd, PhD; Barbara R. Phillips, PhD; Pamela S. Belperio, PharmD; James P. Halloran, RN, MSN, CNS; Ronald O. Valdiserri, MD, MPH; Larry A. Mole, PharmD

Arch Intern Med. 2010;170(14):1239-1246. doi:10.1001/archinternmed.2010.234

Background  Information technology promises to improve health care through reporting of standardized quality-of-care measures. In 2008, the National Quality Forum (NQF) first endorsed performance measures for human immunodeficiency virus (HIV)/AIDS care. Little is known about performance on these measures in routine medical practice. We assessed performance using available electronic data for the large, diverse population with HIV in the Department of Veterans Affairs (VA) and evaluated the influence of patient and resource factors.

Methods  In a retrospective analysis of observational data for 21 564 patients with HIV receiving VA medical care in 2008, we determined performance rates for 10 NQF measures for HIV/AIDS care for the VA nationwide and for 73 facilities with caseloads of 100 or more patients with HIV.

Results  National rates for 6 measures were greater than 80%; the remaining measures and their rates were as follows: annual syphilis screening (54%), tuberculosis screening (65%), Pneumocystis pneumonia prophylaxis (72%), and HIV RNA control (73%). For all measures, rates varied across facilities. In multivariate logistic regression models, African Americans and hard drug users were less likely to access care and less likely to receive HIV-specific care but more likely to receive indicated general medical care. Resource factors (number of primary care/infectious disease outpatient visits, duration of care, and larger facility caseload) were associated with increased likelihood of receipt of indicated general and HIV-specific care.

Conclusions  National performance rates were generally high, but variation in rates across facilities revealed room for improvement. Both patient and resource factors had an impact on the likelihood of receipt of indicated care.

Author Affiliations: Center for Quality Management in Public Health, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Drs Backus, Boothroyd, Phillips, Belperio, and Mole and Mr Halloran); Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto (Dr Backus); and Public Health Strategic Healthcare Group, Department of Veterans Affairs, Washington, DC (Drs Backus, Boothroyd, Phillips, Belperio, Valdiserri, and Mole and Mr Halloran).

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