Bozzette S A, Phillips B, Asch S, Gifford A L, Lenert L, Menke T, Ortiz E, Owens D, Deyton L
Veterans Affairs San Diego Healthcare System and the University of California San Diego, USA.
Med Care. 2000 Jun;38(6 Suppl 1):I60-9. doi: 10.1097/00005650-200006001-00007.
The Veterans Health Administration (VHA) sees approximately equal to 17,000 human immunodeficiency virus (HIV)-infected patients each year, which makes it the largest provider of HIV care in the United States. HIV causes chronic progressive disease that leads to early death. Newer combination antiretro viral treatments are effective but expensive and difficult to use. The HIV Quality Enhancement Research Initiative (HIV-QUERI) uses the QUERI process to identify high-risk and high-volume populations (step 1), which includes those already under VHA care for HIV, those who do not know of their infection, and those at risk for HIV. In identifying best practices (step 2), the HIV-QUERI will benefit greatly from existing guidelines for the care of established HIV infection, but gaps in knowledge regarding adherence to medication regimens and cost-effective screening are large. To identify existing practice patterns (step 3), the HIV-QUERI will develop a clean analytic data set based on Immunology Case Registry files and expand it through a survey of veterans. Interventions to improve care (step 4) will include national, regional, and site-specific feedback on performance relative to quality standards, as well as patient-level and provider-level interventions to improve adherence and support medical decision-making. To document that best practices improve outcomes and quality of life (steps 5 and 6), HIV-QUERI will track indicators on an ongoing basis by use of the Immunology Case Registry database and possible future waves of the survey. In addition, we will require that these issues be addressed in evaluations of HIV-QUERI interventions. In the present article, we present these steps within a framework and plan.
退伍军人健康管理局（VHA）每年接待约17000名感染人类免疫缺陷病毒（HIV）的患者，这使其成为美国最大的HIV护理服务提供者。HIV会引发导致过早死亡的慢性进行性疾病。新型联合抗逆转录病毒疗法有效，但价格昂贵且使用困难。HIV质量提升研究计划（HIV-QUERI）利用QUERI流程来识别高风险和高流量人群（第一步），其中包括那些已经在VHA接受HIV护理的患者、那些不知道自己已感染的人以及有感染HIV风险的人。在确定最佳实践（第二步）时，HIV-QUERI将从现有的已确诊HIV感染护理指南中受益匪浅，但在药物治疗方案依从性和成本效益筛查方面的知识差距很大。为了确定现有的实践模式（第三步），HIV-QUERI将基于免疫学病例登记文件开发一个纯净的分析数据集，并通过对退伍军人的调查加以扩充。改善护理的干预措施（第四步）将包括针对相对于质量标准的绩效提供国家、区域和特定地点的反馈，以及针对患者层面和提供者层面的干预措施，以提高依从性并支持医疗决策。为了证明最佳实践能够改善结果和生活质量（第五步和第六步），HIV-QUERI将通过使用免疫学病例登记数据库以及未来可能进行的几轮调查持续跟踪各项指标。此外，我们将要求在对HIV-QUERI干预措施的评估中解决这些问题。在本文中，我们在一个框架和计划内介绍这些步骤。
