Riera Melchor, Esteban Herminia, Suarez Ignacio, Palacios Rosario, Lozano Fernando, Blanco Jose R, Valencia Eulalia, Ocampo Antonio, Amador Concha, Frontera Guillem, vonWichmann-de Miguel Miguel Angel
Servicio de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitari Son Espases, IDIPSA, Palma de Mallorca, Islas Baleares, España.
Fundación SEIMC, GESIDA, Madrid, España.
Enferm Infecc Microbiol Clin. 2016 Jun-Jul;34(6):346-52. doi: 10.1016/j.eimc.2015.09.003. Epub 2015 Nov 1.
The objective of the study is to validate the relevant GESIDA quality indicators for HIV infection, assessing the reliability, feasibility and adherence to them.
The reliability was evaluated using the reproducibility of 6 indicators in peer review, with the second observer being an outsider. The feasibility and measurement of the level of adherence to the 22 indicators was conducted with annual fragmented retrospective collection of information from specific databases or the clinical charts of the nine participating hospitals.
Reliability was very high, with interobserver agreement levels higher than 95% in 5 of the 6 indicators. The median time to achieve the indicators ranged between 5 and 600minutes, but could be achieved progressively from specific databases, enabling obtaining them automatically. As regards adherence to the indicators related with the initial evaluation of the patients, instructions and suitability of the guidelines for ART, adherence to ART, follow-up in clinics, and achieve an undetectable HIV by PCR at week 48 of the ART. Indicators of quality related to the prevention of opportunistic infections and control of comorbidities, the standards set were not achieved, and significant heterogeneity was observed between hospitals.
The GESIDA quality indicators of HIV infection enabled the relevant indicators to be feasibly and reliably measured, and should be collected in all the units that care for patients with HIV infection.
本研究的目的是验证西班牙艾滋病研究与治疗协作组（GESIDA）针对HIV感染的相关质量指标，评估其可靠性、可行性以及对这些指标的依从性。
通过同行评审中6项指标的可重复性来评估可靠性，第二位观察者为外部人员。通过每年从特定数据库或9家参与医院的临床病历中零散地回顾性收集信息，来进行22项指标的可行性及依从水平的衡量。
可靠性非常高，6项指标中有5项观察者间一致性水平高于95%。达到这些指标的中位时间在5至600分钟之间，但可以从特定数据库逐步实现，从而能够自动获取这些指标。关于患者初始评估、抗逆转录病毒治疗（ART）指南的说明及适用性、ART依从性、门诊随访以及在ART第48周时通过聚合酶链反应（PCR）检测不到HIV等相关指标的依从情况。与预防机会性感染和控制合并症相关的质量指标，设定的标准未达成，且各医院之间观察到显著的异质性。
GESIDA的HIV感染质量指标能够对相关指标进行可行且可靠的测量，应在所有护理HIV感染患者的单位进行收集。
