IOM report outlines core indicators of HIV clinical care

The Institute of Medicine has issued a report identifying the core indicators related to continuous HIV clinical care and access to supportive services for those with HIV, as requested by the White House Office of National AIDS Policy.

The Institute of Medicine (IOM) has also been tasked with monitoring the effect of both the National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act on improving patient care, according to a report brief issued by the IOM.

According to Erika Martin, PhD, assistant professor of public administration and policy at the University at Albany, State University of New York, and one of the committee members who wrote the report, the Patient Protection and Affordable Care Act should increase access to care for patients with HIV and improve the quality of care these patients receive.

The National HIV/AIDS Strategy has three goals: a goal to reduce the number of new infections; a goal to improve access to care and improve health outcomes; and a goal to reduce disparities among those living with HIV, Martin said.

“The problem is that we need some way to monitor how well these two new federal policies work,” she told Infectious Diseases in Children. “This report tackles two major issues: What is the right way to evaluate success, and what kind of data sources can be used to do so?”

Indicators and data collection

The first half of the IOM report tackles how to evaluate success with the recommendation of 12 core indicators to evaluate the effect of the two new policies. According to the report brief, there are many obstacles that prevent those with HIV from reaching optimal health, ranging from late diagnosis and delayed access to care to delayed prescription and intermittent use of antiretroviral therapy. The core indictors measure clinical HIV care, access to treatment for substance abuse and mental health disorders, and access to supportive services.

The second half of the IOM report considers strategies to obtain data on these core indicators. According to Martin, there are many data systems from which the data on these indicators can be obtained. However, patients with HIV do not typically receive all of their care for all of their conditions at the same place, and they may have their medical and social support services financed by multiple payors, making it difficult to create a streamlined record on all of the care a particular patient has received.

“The challenge is that many of these different data systems, such as electronic clinical records, Medicaid claims data, Medicare claims data and private insurance data, are not interoperable,” Martin said. “At this time, it’s virtually impossible to create one big dataset that will contain all of the information on a single patient throughout the course of their infection. That’s a major challenge when monitoring all the different indicators, and their improvement over time.”

Physician awareness

One aspect of the report that is relevant to providers of HIV/AIDS care is simply to have an awareness of the National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act, Martin said.

“Clinicians should know about how these two policies affect their patients,” she said. “Both of these policies have the potential to improve HIV patients’ access to care, thereby improving their health.”

Also of relevance to providers is the list of core indicators, which should give them additional information about the important elements of HIV care, Martin said. Aside from treatment for their disease, it is important to make sure patients have access to adequate social services, mental health and substance abuse services and issues such as housing, transportation and food assistance.

“It’s not just about getting patients into clinics and into care,” Martin said. “It’s also important to think about what is required to maintain patients in care and to make sure they receive high quality service.” – by Emily Shafer

Disclosure: Dr. Martin reports no relevant financial disclosures.

The Institute of Medicine has issued a report identifying the core indicators related to continuous HIV clinical care and access to supportive services for those with HIV, as requested by the White House Office of National AIDS Policy.

The Institute of Medicine (IOM) has also been tasked with monitoring the effect of both the National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act on improving patient care, according to a report brief issued by the IOM.

According to Erika Martin, PhD, assistant professor of public administration and policy at the University at Albany, State University of New York, and one of the committee members who wrote the report, the Patient Protection and Affordable Care Act should increase access to care for patients with HIV and improve the quality of care these patients receive.

The National HIV/AIDS Strategy has three goals: a goal to reduce the number of new infections; a goal to improve access to care and improve health outcomes; and a goal to reduce disparities among those living with HIV, Martin said.

“The problem is that we need some way to monitor how well these two new federal policies work,” she told Infectious Diseases in Children. “This report tackles two major issues: What is the right way to evaluate success, and what kind of data sources can be used to do so?”

Indicators and data collection

The first half of the IOM report tackles how to evaluate success with the recommendation of 12 core indicators to evaluate the effect of the two new policies. According to the report brief, there are many obstacles that prevent those with HIV from reaching optimal health, ranging from late diagnosis and delayed access to care to delayed prescription and intermittent use of antiretroviral therapy. The core indictors measure clinical HIV care, access to treatment for substance abuse and mental health disorders, and access to supportive services.

The second half of the IOM report considers strategies to obtain data on these core indicators. According to Martin, there are many data systems from which the data on these indicators can be obtained. However, patients with HIV do not typically receive all of their care for all of their conditions at the same place, and they may have their medical and social support services financed by multiple payors, making it difficult to create a streamlined record on all of the care a particular patient has received.

“The challenge is that many of these different data systems, such as electronic clinical records, Medicaid claims data, Medicare claims data and private insurance data, are not interoperable,” Martin said. “At this time, it’s virtually impossible to create one big dataset that will contain all of the information on a single patient throughout the course of their infection. That’s a major challenge when monitoring all the different indicators, and their improvement over time.”

Physician awareness

One aspect of the report that is relevant to providers of HIV/AIDS care is simply to have an awareness of the National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act, Martin said.

“Clinicians should know about how these two policies affect their patients,” she said. “Both of these policies have the potential to improve HIV patients’ access to care, thereby improving their health.”

Also of relevance to providers is the list of core indicators, which should give them additional information about the important elements of HIV care, Martin said. Aside from treatment for their disease, it is important to make sure patients have access to adequate social services, mental health and substance abuse services and issues such as housing, transportation and food assistance.

“It’s not just about getting patients into clinics and into care,” Martin said. “It’s also important to think about what is required to maintain patients in care and to make sure they receive high quality service.” – by Emily Shafer

Disclosure: Dr. Martin reports no relevant financial disclosures.