Improved quality of HIV care over time among participants in a national quality improvement initiative.

Ensuring comprehensive quality HIV and primary care is critical for effective HIV management. This study evaluates the impact of long-term engagement in a quality management (QM) initiative on performance measures. HIVQUAL-US is a federally-funded program to build clinic QM capacity to improve care for people living with HIV/AIDS. Forty-five facilities with four or more years of HIVQUAL-US performance measurement between 2002 and 2009 were included. Composite quality scores were constructed for HIV care, primary care and overall quality. Unadjusted analyses showed significant improvements in HIV care (76.2% to 88.8%, p<.0001), primary care (65.7% to 71.4%, p<.05) and overall (70.6% to 79.6%, p<.0001). Improvement was higher among clinics performing in the lowest quartile. Adjusting for clinic factors, the probability of improvement increased with each additional year of data submission for all scores. Engagement in a QM capacity building program was associated with continuing improvement in quality of HIV and primary care.