A Quality Assurance Program for the Care of Persons Living with HIV Infection

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Abstract
Many different models have been developed for health care delivery to HIV-infected persons. Nevertheless, limited experience has been accumulated in the development of evaluation activities of the system of care. We report on a quality assessment program implemented at our institution that is coordinating the delivery of care to the whole community of HIV-infected persons living in the Bergamo province. A total of 1599 patients, mostly IV drug users, were included in the study, during 1985-1992. Following three years of testing, we selected a number of demographic and clinical parameters in order to define the studied population and to allow computing of two outcome criteria and three process criteria: evaluating survival, incidence of major opportunistic infections (OIs), length of the follow-up preceding the diagnosis of AIDS, timeliness of initiation of antiretroviral therapy, and rate of hospitalization. Other criteria related to drop-out, quality of life, and patients' satisfaction have been excluded as unwieldy and/or unreliable. The final version of our program is a simple computerized tool incorporated into routine clinical practice, which may prove useful for the longitudinal monitoring of the quality of care, and for the comparison of different systems of care.