J Healthc Qual. 2021;43(3):174-182. doi: 10.1097/JHQ.0000000000000277.
Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. We assessed HIV care quality with four national measures adapted for the NH setting. We applied the measures to 2011-2013 Medicare claims linked to Minimum Data Set assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Cox proportional hazards models calculated the risk of all-cause and HIV/AIDS-related hospitalization by HIV care compliance. We identified 1,246 PLWH in 201 NHs with 382 all-cause and 63 HIV/AIDS-related hospitalizations. Nursing home HIV care compliance varied from 24.9% to 64.7%. After regression adjustment, we could detect no difference in all-cause or HIV/AIDS-related hospitalizations by NH HIV care compliance. We postulate that the lack of association may be due to inappropriate HIV care quality measures that do not accurately represent NHs ability to care for PLWH. There is urgent need to create valid NH HIV care quality measures.
感染艾滋病毒/艾滋病（PLWH）的人寿命足够长，需要与年龄相关和与艾滋病毒相关的疗养院（NH）护理。疗养院的护理质量与住院风险有关，但尚不清楚 NH 中的艾滋病毒护理质量是否会影响该人群的住院率。我们使用四项针对 NH 环境进行调整的国家措施来评估艾滋病毒护理质量。我们将这些措施应用于 2011 年至 2013 年的 Medicare 索赔，这些索赔与居民健康的最低数据集评估、处方配药数据以及 NH 特征的国家报告相关联。Cox 比例风险模型通过 HIV 护理依从性计算了全因和 HIV/AIDS 相关住院的风险。我们在 201 家 NH 中确定了 1246 名 PLWH，其中有 382 例全因和 63 例 HIV/AIDS 相关住院。NH 艾滋病毒护理依从性从 24.9%到 64.7%不等。经过回归调整后，我们无法根据 NH 艾滋病毒护理依从性检测到全因或 HIV/AIDS 相关住院的差异。我们推测，缺乏关联可能是由于不适当的艾滋病毒护理质量措施无法准确反映 NH 照顾 PLWH 的能力。迫切需要创建有效的 NH 艾滋病毒护理质量措施。
