Hirschhorn Lisa R, Landers Stewart, McInnes D Keith, Malitz Faye, Ding Lin, Joyce Rebecca, Cleary Paul D
John Snow, JSI Research and Training Institute, Boston, MA, USA.
AIDS Care. 2009 Jun;21(6):799-807. doi: 10.1080/09540120802511992.
Since 1991, the US Government has funded medical and support services for people living with HIV and AIDS (PLWHA) through the Ryan White HIV/AIDS Program. The Ryan White Program supports networks of care which include medical care providers and support services for PLWHA in 51 Eligible Metropolitan Areas (EMAs). In the 2000 reauthorization of the Ryan White Program, quality management programs were required for all sites receiving funding. To facilitate quality management and improvement activities in EMAs, we developed a set of surveys to measure characteristics of care networks and the quality, accessibility, and coordination of services from the perspective of case management and medical providers, administrators and consumers. The surveys measured quality management and support activities of the entire network, as well as reported quality of services at individual care sites. They were administered in 42 EMAs from a total of 43 who had not participated in earlier pilot testing and were located in the continental US. The care networks were rated highly on access, quality, and coordination between case management and primary care providers. However, there were frequently differences in ratings of quality and barriers by type of respondent (consumer representatives, Grantees, and providers). There were also substantial variations across EMAs in network characteristics, perceived effectiveness, performance measurement, and quality improvement activities. The results indicate that the Ryan White Program has been successful in some areas of developing networks of care, but additional support is needed to strengthen the comprehensiveness and coordination of care. Additional work also is needed to better define and measure the essential characteristics of coordinated and integrated networks of care and assess whether those characteristics are related to access and quality of care and services.
自1991年以来，美国政府通过瑞安·怀特艾滋病毒/艾滋病项目为感染艾滋病毒和艾滋病的患者（PLWHA）提供医疗和支持服务。瑞安·怀特项目支持护理网络，其中包括为51个符合条件的大都市区（EMA）的PLWHA提供医疗服务的提供者和支持服务。在2000年瑞安·怀特项目重新授权时，要求所有获得资金的站点实施质量管理项目。为了促进EMA的质量管理和改进活动，我们开发了一套调查，从病例管理、医疗服务提供者、管理人员和消费者的角度衡量护理网络的特征以及服务的质量、可及性和协调性。这些调查衡量了整个网络的质量管理和支持活动，以及各个护理站点报告的服务质量。调查在43个未参与早期试点测试且位于美国大陆的EMA中的42个进行。护理网络在可及性、质量以及病例管理与初级护理提供者之间的协调性方面获得了高度评价。然而，不同类型的受访者（消费者代表、受赠者和提供者）对质量和障碍的评级经常存在差异。在网络特征、感知效果、绩效衡量和质量改进活动方面，各EMA之间也存在很大差异。结果表明，瑞安·怀特项目在发展护理网络的某些方面取得了成功，但需要额外的支持来加强护理的全面性和协调性。还需要开展更多工作，以更好地界定和衡量协调和综合护理网络的基本特征，并评估这些特征是否与护理和服务质量及可及性相关。
