Thailand Ministry of Public Health (MOPH), Nonthaburi 11000, Thailand.
Int J Qual Health Care. 2012 Aug;24(4):338-47. doi: 10.1093/intqhc/mzs008. Epub 2012 Jun 3.
We report experience of HIVQUAL-T implementation in Thailand.
Program evaluation.
Twelve government hospital clinics.
People living with HIV/AIDS (PLHAs) aged ≥15 years with two or more visits to the hospitals during 2002-08.
HIVQUAL-T is a process for HIV care performance measurement (PM) and quality improvement (QI). The program includes PM using a sample of eligible cases and establishment of a locally led QI infrastructure and process. PM indicators are based on Thai national HIV care guidelines. QI projects address needs identified through PM; regional workshops facilitate peer learning. Annual benchmarking with repeat measurement is used to monitor progress.
Percentages of eligible cases receiving various HIV services.
Across 12 participating hospitals, HIV care caseloads were 4855 in 2002 and 13 887 in 2008. On average, 10-15% of cases were included in the PM sample. Percentages of eligible cases receiving CD4 testing in 2002 and 2008, respectively, were 24 and 99% (P< 0.001); for ARV treatment, 100 and 90% (P= 0.74); for Pneumocystis jiroveci pneumonia prophylaxis, 94 and 93% (P= 0.95); for Papanicolau smear, 0 and 67% (P< 0.001); for syphilis screening, 0 and 94% (P< 0.001); and for tuberculosis screening, 24 and 99% (P< 0.01). PM results contributed to local QI projects and national policy changes.
Hospitals participating in HIVQUAL-T significantly increased their performance in several fundamental areas of HIV care linked to health outcomes for PLHA. This model of PM-QI has improved clinical care and implementation of HIV guidelines in hospital-based clinics in Thailand.
我们报告在泰国实施 HIVQUAL-T 的经验。
方案评估。
12 家政府医院诊所。
年龄≥15 岁，在 2002-08 年期间到医院就诊两次或以上的 HIV 感染者/艾滋病患者（PLHA）。
HIVQUAL-T 是一项用于 HIV 护理绩效测量（PM）和质量改进（QI）的方案。该方案包括使用合格病例样本进行 PM，并建立当地领导的 QI 基础设施和流程。PM 指标基于泰国国家 HIV 护理指南。QI 项目解决通过 PM 确定的需求；区域研讨会促进同行学习。使用年度基准测试和重复测量来监测进展。
接受各种 HIV 服务的合格病例比例。
在 12 家参与医院中，HIV 护理患者人数从 2002 年的 4855 例增加到 2008 年的 13887 例。平均而言，10-15%的病例纳入 PM 样本。2002 年和 2008 年分别有 24%和 99%的合格病例接受 CD4 检测（P<0.001）；接受 ARV 治疗的比例分别为 100%和 90%（P=0.74）；接受肺孢子菌肺炎预防的比例分别为 94%和 93%（P=0.95）；接受巴氏涂片检查的比例分别为 0%和 67%（P<0.001）；接受梅毒筛查的比例分别为 0%和 94%（P<0.001）；接受结核病筛查的比例分别为 24%和 99%（P<0.01）。PM 结果促成了当地 QI 项目和国家政策的改变。
参与 HIVQUAL-T 的医院在与 PLHA 健康结果相关的几项 HIV 护理基本领域的表现显著提高。这种 PM-QI 模式改善了泰国医院诊所的临床护理和 HIV 指南的实施。
