Improving HIV outcomes in resource-limited countries: the importance of quality indicators
Identifieur interne : 003323 ( Main/Exploration ); précédent : 003322; suivant : 003324Improving HIV outcomes in resource-limited countries: the importance of quality indicators
Auteurs : Aima A. Ahonkhai [États-Unis] ; Ingrid V. Bassett [États-Unis] ; Timothy G. Ferris [États-Unis] ; Kenneth A. Freedberg [États-Unis]Source :
- BMC Health Services Research [ 1472-6963 ] ; 2012.
Abstract
Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped.
Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment.
This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level.
An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.
Url:
DOI: 10.1186/1472-6963-12-427
PubMed: 23176556
PubMed Central: 3536601
Affiliations:
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Ahonkhai</name><affiliation wicri:level="2"><nlm:aff id="I1">Divisions of Infectious Disease, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Divisions of Infectious Disease, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="I3">Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V" last="Bassett">Ingrid V. Bassett</name><affiliation wicri:level="2"><nlm:aff id="I1">Divisions of Infectious Disease, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Divisions of Infectious Disease, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="I2">General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="I3">Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Ferris, Timothy G" sort="Ferris, Timothy G" uniqKey="Ferris T" first="Timothy G" last="Ferris">Timothy G. Ferris</name><affiliation wicri:level="2"><nlm:aff id="I4">Partners Healthcare, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Partners Healthcare, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A" last="Freedberg">Kenneth A. Freedberg</name><affiliation wicri:level="2"><nlm:aff id="I1">Divisions of Infectious Disease, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Divisions of Infectious Disease, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="I2">General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="I3">Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="I5">Harvard University Center for AIDS Research, Harvard University, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard University Center for AIDS Research, Harvard University, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author></analytic><series><title level="j">BMC Health Services Research</title><idno type="eISSN">1472-6963</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped.</p></sec><sec><title>Methods</title><p>Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment.</p></sec><sec><title>Results</title><p>This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level.</p></sec><sec><title>Conclusion</title><p>An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Micek, Ma" uniqKey="Micek M">MA Micek</name></author><author><name sortKey="Gimbel Sherr, K" uniqKey="Gimbel Sherr K">K Gimbel-Sherr</name></author><author><name sortKey="Baptista, Aj" uniqKey="Baptista A">AJ Baptista</name></author><author><name sortKey="Matediana, E" uniqKey="Matediana E">E Matediana</name></author><author><name sortKey="Montoya, P" uniqKey="Montoya P">P Montoya</name></author><author><name sortKey="Pfeiffer, J" uniqKey="Pfeiffer J">J Pfeiffer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bassett, Iv" uniqKey="Bassett I">IV Bassett</name></author><author><name sortKey="Regan, S" uniqKey="Regan S">S 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sortKey="Meulemans, H" uniqKey="Meulemans H">H Meulemans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Myburgh, Ng" uniqKey="Myburgh N">NG Myburgh</name></author><author><name sortKey="Solanki, Gc" uniqKey="Solanki G">GC Solanki</name></author><author><name sortKey="Smith, Mj" uniqKey="Smith M">MJ Smith</name></author><author><name sortKey="Lalloo, R" uniqKey="Lalloo R">R Lalloo</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Brinkhof, Mw" uniqKey="Brinkhof M">MW Brinkhof</name></author><author><name sortKey="Dabis, F" uniqKey="Dabis F">F Dabis</name></author><author><name sortKey="Myer, L" uniqKey="Myer L">L Myer</name></author><author><name sortKey="Bangsberg, Dr" uniqKey="Bangsberg D">DR Bangsberg</name></author><author><name sortKey="Boulle, A" uniqKey="Boulle A">A Boulle</name></author><author><name sortKey="Nash, D" uniqKey="Nash D">D Nash</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Massachusetts</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Ahonkhai, Aima A" sort="Ahonkhai, Aima A" uniqKey="Ahonkhai A" first="Aima A" last="Ahonkhai">Aima A. Ahonkhai</name></region><name sortKey="Ahonkhai, Aima A" sort="Ahonkhai, Aima A" uniqKey="Ahonkhai A" first="Aima A" last="Ahonkhai">Aima A. Ahonkhai</name><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V" last="Bassett">Ingrid V. Bassett</name><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V" last="Bassett">Ingrid V. Bassett</name><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V" last="Bassett">Ingrid V. Bassett</name><name sortKey="Ferris, Timothy G" sort="Ferris, Timothy G" uniqKey="Ferris T" first="Timothy G" last="Ferris">Timothy G. Ferris</name><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A" last="Freedberg">Kenneth A. Freedberg</name><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A" last="Freedberg">Kenneth A. Freedberg</name><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A" last="Freedberg">Kenneth A. Freedberg</name><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A" last="Freedberg">Kenneth A. Freedberg</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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