Ahonkhai Aima A, Onwuatuelo Ifeyinwa, Regan Susan, Adegoke Abdulkabir, Losina Elena, Banigbe Bolanle, Adeola Juliet, Ferris Timothy G, Okonkwo Prosper, Freedberg Kenneth A
Division of infectious Disease, Massachusetts General Hospital, Boston, MA, USA.
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Int J Qual Health Care. 2017 Oct 1;29(5):654-661. doi: 10.1093/intqhc/mzx083.
HIV care delivery in resource-limited settings (RLS) may serve as a paradigm for chronic disease care, but comprehensive measurement frameworks are lacking. Our objective was to adapt the patient-centered medical home (PCMH) framework for use in RLS, and evaluate the performance of HIV treatment programs within this framework.
Cross-sectional survey administered within the AIDS Prevention Initiative in Nigeria (APIN) network.
Medical directors at APIN clinics.
We adapted the 2011 US National Committee on Quality Assurance's PCMH standard to develop a survey measuring five domains of HIV care: (i) enhancing access and continuity, (ii) identifying and managing patient populations, (iii) planning and managing care, (iv) promoting self-care and support and (v) measuring and improving performance.
Thirty-three of 36 clinics completed the survey. Most were public (73%) and urban/semi-urban (64%); 52% had >500 patients in care. On a 0-100 scale, clinics scored highest in self-care and support, 91% (63-100%); managing patient populations, 80% (72-81%) and improving performance, 72% (44-78%). Clinics scored lowest with the most variability in planning/managing care, 65% (22-89%), and access and continuity, 61% (33-80%). Average score across all domains was 72% (58-81%).
Our findings suggest that the modified PCMH tool is feasible, and likely has sufficient performance variation to discriminate among clinics. Consistent with extant literature, clinics showed greatest room for improvement on access and continuity, supporting the tool's face validity. The modified PCMH tool may provide a powerful framework for evaluating chronic HIV care in RLS.
在资源有限的环境中提供艾滋病护理服务或许可以成为慢性病护理的典范，但目前仍缺乏全面的衡量框架。我们的目标是调整以患者为中心的医疗之家（PCMH）框架，使其适用于资源有限的环境，并在此框架内评估艾滋病治疗项目的绩效。
在尼日利亚艾滋病预防倡议（APIN）网络内进行的横断面调查。
APIN诊所的医疗主任。
我们对2011年美国国家质量保证委员会的PCMH标准进行了调整，以开发一项衡量艾滋病护理五个领域的调查：（i）增加可及性和连续性；（ii）识别和管理患者群体；（iii）规划和管理护理；（iv）促进自我护理和支持；（v）衡量和改善绩效。
36家诊所中的33家完成了调查。大多数诊所是公立的（73%），位于城市/半城市地区（64%）；52%的诊所护理患者超过500人。在0至100分的评分标准下，诊所在自我护理和支持方面得分最高，为91%（63 - 100%）；在管理患者群体方面得分80%（72 - 81%），在改善绩效方面得分72%（44 - 78%）。诊所在规划/管理护理方面得分最低且差异最大，为65%（22 - 89%），在可及性和连续性方面得分61%（33 - 80%）。所有领域的平均得分为72%（58 - 81%）。
我们的研究结果表明，经过修改的PCMH工具是可行的，并且可能具有足够的绩效差异来区分不同诊所。与现有文献一致，诊所在可及性和连续性方面显示出最大的改进空间，这支持了该工具的表面效度。经过修改的PCMH工具可能为评估资源有限环境中的慢性艾滋病护理提供一个有力的框架。
