Lolekha Rangsima, Chunwimaleung Suchin, Hansudewechakul Rawiwan, Leawsrisook Pimsiri, Prasitsuebsai Wasana, Srisamang Pramot, Wongsawat Jurai, Faikratok Worawan, Pattanasin Sarika, Agins Bruce D, Fox Kimberley K, McConnell Michelle S
Preventing-Mother-to-Child HIV Transmission and Pediatrics, Global AIDS Program Asia Regional Office, Thailand Ministry of Public Health-U.S. Centers for Disease and Control and Prevention Collaboration, Nonthaburi, Thailand.
Jt Comm J Qual Patient Saf. 2010 Dec;36(12):541-51. doi: 10.1016/s1553-7250(10)36082-x.
As increasing numbers of children initiate antiretroviral treatment (ART), a systematic process is needed to measure and improve pediatric HIV care quality.
Pediatric HIVQUAL-T, a model for performance measurement and quality improvement (QI), was adapted from the U.S. HIVQUAL model by incorporating Thai national guidelines as standards. In each of five pilot-site hospitals in Thailand in 2005-2007, clinical data abstracted from patient records were used to identify priority areas for QI. Improvement strategies were designed by clinic teams in different care system areas, and indicators were remeasured in 2006 and 2007.
At the five hospitals, 1119 HIV-infected children younger than 15 years of age received care in 2005, 1183 in 2006, and 1,341 in 2007--of whom 460, 435, and 418, respectively, were selected for chart abstraction. Of the eligible children, > or = 95% received clinical monitoring, annual CD4 count monitoring, ART, and adherence and growth assessments; 60%-90% received Pneumocystis jiroveci pneumonia (PCP) prophylaxis, tuberculosis (TB) screening, oral health assessments, and HIV disclosure. Indicators with a score < or = 40% in 2005 but with significant improvement (p < .05) in 2006-2007 following QI activities were Mycobacterium avium complex (MAC) prophylaxis, and cytomegalovirus (CMV) retinitis and immunization screenings.
Despite the promulgation of national guidelines, performance rates of some pediatric HIV indicators needed improvement. The pediatric HIVQUAL-T model facilitates use of hospital data for pediatric HIV care improvement and indicates that the U.S. HIVQUAL model is adaptable to developing countries.
随着越来越多的儿童开始接受抗逆转录病毒治疗（ART），需要一个系统的流程来衡量和改善儿科艾滋病毒护理质量。
儿科HIVQUAL-T是一种绩效衡量和质量改进（QI）模型，它通过将泰国国家指南作为标准，对美国HIVQUAL模型进行了改编。2005年至2007年期间，在泰国的五家试点医院中，从患者记录中提取的临床数据被用于确定质量改进的优先领域。不同护理系统领域的临床团队设计了改进策略，并在2006年和2007年对指标进行了重新测量。
在这五家医院中，2005年有1119名15岁以下的艾滋病毒感染儿童接受了护理，2006年有1183名，2007年有1341名，其中分别有460名、435名和418名被选作病历摘要分析。在符合条件的儿童中，≥95%接受了临床监测、年度CD4细胞计数监测、抗逆转录病毒治疗以及依从性和生长评估；60% - 90%接受了耶氏肺孢子菌肺炎（PCP）预防、结核病（TB）筛查、口腔健康评估以及艾滋病毒信息披露。在2005年得分≤40%但在2006 - 2007年质量改进活动后有显著改善（p <.05）的指标是鸟分枝杆菌复合体（MAC）预防、巨细胞病毒（CMV）视网膜炎和免疫筛查。
尽管颁布了国家指南，但一些儿科艾滋病毒指标的执行率仍需提高。儿科HIVQUAL-T模型有助于利用医院数据来改善儿科艾滋病毒护理，并表明美国HIVQUAL模型适用于发展中国家。
