A STATEWIDE PROGRAM TO EVALUATE THE QUALITY OF CARE PROVIDED TO PERSONS WITH HIV-INFECTION

Objective: To develop a state-based system for evaluating the quality of HIV clinical services in New York State using techniques of continu ous quality improvement (CQI). Design: Using CQI techniques instead of the customary regulatory approach of formal citation, this government -sponsored initiative was tested in a pilot program in 1992. Specific clinical procedures were selected by physicians as priorities for meas uring quality in medical records of individuals infected with HIV. The se aspects of care were converted into algorithms from which indicator s were chosen, and evaluated through medical record abstraction and da ta collection. Program review results are presented as aggregate data so that providers can evaluate overall performance rather than focus o n individual cases. Results from other facilities are provided as well , in a format that permits comparative evaluation without loss of conf identiality. The state uses these data or results to evaluate clinical program effectiveness and to target providers in need of assistance. When significant difficulties in delivering basic clinical services ar e identified, the facility in question Is expected to review the infor mation and launch its own quality monitoring program. To assist facili ties that lack resources to develop such programs, the AIDS Institute has created a quality improvement consultation service designed to ass ist health care facilities in the development of their own HIV quality improvement programs. Results: Data compiled from quality of care rev iews are grouped according to facility type. This format permits both analysis of results over time and between different types of program m odels. Comparative results based on 1,575 records in year one and 1,82 9 records in year two presented by facility type indicate consistent p erformance in HIV disease staging, Pneumocystis carinii pneumonia (PCP ) prophylaxis, and antiretroviral therapy, as well as improvement in p erformance of pelvic examination. Provider responses indicated that th e program was successful in its first year. Case studies illustrate th e positive effects of CQI-based reviews. Several key elements for succ essful development of such a review program are highlighted. Conclusio ns: The HIV-specific quality-of-care evaluation program shows that reg ulatory bodies can depart from traditional review techniques and adopt more effective and positive means of improving care. This unique HIV- specific quality of care program can serve as a model for developing g overnment-sponsored, CQI-based quality monitoring programs for use wit h other chronic illnesses and in diverse clinical settings.