The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts.
Department of Health Sciences, Northeastern University, Boston, Massachusetts.
J Am Geriatr Soc. 2020 Jun;68(6):1226-1234. doi: 10.1111/jgs.16359. Epub 2020 Feb 13.
Quality of human immunodeficiency virus (HIV) care in nursing homes (NHs) has never been measured.
A cross-sectional study.
NHs.
A total of 203 NHs and 1375 persons living with HIV.
Medicare claims from 2011 to 2013 were linked to assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Five nationally validated HIV care quality measures (prescription of antiretroviral therapy; CD4/viral load monitoring; frequency of medical visits; gaps in medical visits; and Pneumocystis pneumonia prophylaxis) were adapted and applied to NHs. Logistic regression predicted compliance by organizational factors. Random intercept logistic regression predicted if persons living with HIV received care by person and organizational factors.
Compliance ranged from 43.3% (SD = 31.1%) for CD4/viral load monitoring to 92.4% (SD = 13.6%) for gaps in medical visits. More substantiated complaints against an NH decreased the likelihood of high compliance with CD4/viral load monitoring (odds ratio [OR] = 0.846; 95% confidence interval [CI] = 0.726-0.986), while NH-reported incidents increased the likelihood of high compliance with pneumocystis pneumonia prophylaxis (OR = 1.173; 95% CI = 1.044-1.317). Differences between NHs explained 21.2% or less of variability in receipt of care.
Since 2013, the population with HIV and NH HIV care quality has inevitably evolved; however, this study provides previously unknown baseline metrics on NH HIV care quality and highlights significant challenges when measuring HIV care in NHs. J Am Geriatr Soc 68:1226-1234, 2020.
养老院（NHs）中的人类免疫缺陷病毒（HIV）护理质量从未被测量过。
一项横断面研究。
NHs。
共有 203 家 NHs 和 1375 名 HIV 感染者。
将 2011 年至 2013 年的医疗保险索赔与居民健康评估、处方配药数据和 NH 特征的国家报告相联系。五项经国家验证的 HIV 护理质量措施（抗逆转录病毒治疗的处方；CD4/病毒载量监测；医疗就诊频率；医疗就诊间隙；和卡氏肺孢子虫肺炎预防）进行了调整并应用于 NHs。逻辑回归预测了组织因素对合规性的影响。随机截距逻辑回归预测了 HIV 感染者是否按人和组织因素接受护理。
合规性范围从 CD4/病毒载量监测的 43.3%（SD=31.1%）到医疗就诊间隙的 92.4%（SD=13.6%）。对 NH 的更多证实投诉降低了 CD4/病毒载量监测高合规性的可能性（比值比[OR] = 0.846；95%置信区间[CI] = 0.726-0.986），而 NH 报告的事件增加了对卡氏肺孢子虫肺炎预防高合规性的可能性（OR = 1.173；95% CI = 1.044-1.317）。NH 之间的差异解释了接受护理的变异性的 21.2%或更少。
自 2013 年以来，HIV 感染者和 NHs HIV 护理质量不可避免地发生了演变；然而，本研究提供了 NHs HIV 护理质量的先前未知的基线指标，并突出了在 NHs 中测量 HIV 护理时面临的重大挑战。美国老年医学会 68:1226-1234, 2020.
