Collaborative management of HIV infection in the community: an effort to improve the quality of HIV care

Abstract

Our hospital led a multidisciplinary community team to improve the quality of care delivered to HIV-infected clients utilizing a disease management approach in a US metropolitan community of 150,000 people. Community needs assessment and client and community surveys were used to define the problems. Patient care flowcharting and the creation of an electronic patient database facilitated patient tracking across the entire community. Clinical guidelines and a consultation and referral immunology clinic standardized care practices. Measurable improvements in the quality of care were noted in multiple areas. Flowchart completion rates rose from 44% to 100%; medication adherence assessment rose from 82% to 100%; immunization rates rose from a mean of 72% to a mean of 87%; PPD screening rose from a low of 35% to a high of 87%; perinatal transmission rates fell from 31% to 4%; and Emergency Department utilization decreased. Two essential components of the effort were the establishment of a full-time leadership position in the form of a clinical nurse practitioner and the creation of an electronic database with flowcharting to standardize the measurement, delivery and tracking of care. The programme has become an example of successful disease management through hospital–community collaboration.

Acknowledgments

This initiative was the winner of the 2001 Connecticut Hospital Association John D. Thompson award for excellence in health care in recognition of efforts to improve health care quality through the use of data.

We acknowledge the support of the City of Stamford Department of Health, its Director Anthony Iton, MD, and Director of AIDS Services, Debra Katz; Fay Parport, NP, for her clinical and organizational skills; Stamford CARES and its Director, Laura Crawford, Director of Community Relations Diane Longo, and case managers Sonia Bennett, Cecilia Baldwin and Andre Campos, and therapist Mary Ellen Reynolds; Shara Israel, MD, Medical Director of Ambulatory Practice at Stamford Hospital; Debra Adler-Klein, MD, and Lynda Streett, MD, for their expertise in infectious diseases medicine; James Tucker, RN, for his contribution to graphics and statistical evaluation; and Diane Ricketts and Joan Olson for their office support, without whom none of this programme would have been possible.