Barrow Geoffrey J, Fairley Michael, Brandeau Margaret L
Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica.
Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
Oper Res Health Care. 2020 Jun;25. doi: 10.1016/j.orhc.2020.100258. Epub 2020 May 15.
UNAIDS' 90-90-90 goal for 2020 is for 90% of HIV-infected people to know their status, 90% of infected individuals to receive antiretroviral therapy (ART), and 90% of those on ART to achieve viral suppression. To achieve these ambitious goals, effective care delivery programs are needed. In this paper we present a case study showing how HIV care can be improved by viewing the patient care process as a production process and applying methods of process improvement analysis. We examine the continuum of HIV care at a hospital-based HIV clinic in Kingston, Jamaica. We perform qualitative analysis to identify key programmatic, personnel, and clinical areas for process improvement. We then perform quantitative analysis. We develop a stochastic model of the care process which we use to evaluate the effects of potential process improvements on the number of patients who receive ART and the number who achieve viral suppression. We also develop a model for optimal investment of a fixed budget among interventions aimed at improving the care cascade and we use the model to determine the optimal investment among three interventions that the clinic could invest in. By viewing the patient care process as a production process and applying qualitative and quantitative process improvement analysis, our case study illustrates how clinics can identify the best ways to maximize clinical outcomes. Our methods are generalizable to other HIV care clinics as well as to clinics that provide care for other chronic conditions (e.g., diabetes, hepatitis B, or opioid use disorder).
联合国艾滋病规划署（UNAIDS）制定的2020年90-90-90目标是，让90%的艾滋病毒感染者知晓自身感染状况，90%的感染者接受抗逆转录病毒疗法（ART），90%接受ART治疗的患者实现病毒抑制。为实现这些宏伟目标，需要有效的医疗服务提供项目。在本文中，我们展示了一个案例研究，该研究表明，将患者护理过程视为生产过程并应用过程改进分析方法，可改善艾滋病毒护理。我们考察了牙买加金斯敦一家医院的艾滋病毒诊所的连续护理情况。我们进行定性分析，以确定过程改进的关键项目、人员和临床领域。然后我们进行定量分析。我们开发了一个护理过程的随机模型，用于评估潜在过程改进对接受ART治疗的患者数量和实现病毒抑制的患者数量的影响。我们还开发了一个模型，用于在旨在改善护理流程的干预措施之间对固定预算进行最优投资，并使用该模型确定诊所能投资的三种干预措施中的最优投资。通过将患者护理过程视为生产过程并应用定性和定量的过程改进分析，我们的案例研究说明了诊所如何确定最大化临床结果的最佳方法。我们的方法不仅适用于其他艾滋病毒护理诊所，也适用于为其他慢性病（如糖尿病、乙型肝炎或阿片类药物使用障碍）提供护理的诊所。
