Measuring What Matters: Development of Standard HIV Core Indicators across the U.S. Department of Health and Human Services

Valdiserri, Ronald O.; Forsyth, Andrew D.; Yakovchenko, Vera; Koh, Howard K.

doi:10.1177/003335491312800504

Cited by 66 publications

(70 citation statements)

References 9 publications

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“…Even in a clinically engaged population who have successfully linked to health care, using laboratory measures as proxies for clinical encounters does not provide a complete picture of engagement in care as recommended by recently adopted indicators (9,10,32). The potential for misclassification of an encounter-based retention outcome based on laboratorybased retention measures is small but nontrivial, ranging from 15% discordance to 20% discordance.…”

Section: Discussionmentioning

confidence: 99%

“…In 2010, the National HIV/AIDS Strategy advocated increasing the proportion of HIV-infected patients in continuous care (8); and in 2012, the Institute of Medicine outlined measures for assessing both the National HIV/AIDS Strategy and benchmarks outlined in the Affordable Care Act (9). More recently, the Department of Health and Human Services adopted process indicators for HIV care (10), and the President of the United States issued an Executive Order directing the Office of National AIDS Policy to coordinate a federal response to improve engagement across the HIV care continuum (11,12).…”

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confidence: 99%

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Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Rebeiro¹,

Althoff²,

Lau³

et al. 2015

Am. J. Epidemiol.

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Because of limitations in the availability of data on primary care encounters, patient retention in human immunodeficiency virus (HIV) care is often estimated using laboratory measurement dates as proxies for clinical encounters, leading to possible outcome misclassification. This study included 83,041 HIV-infected adults from 14 clinical cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) who had ≥1 HIV primary care encounters during 2000-2010, contributing 468,816 person-years of follow-up. Encounter-based retention (R EB ) was defined as ≥2 encounters in a calendar year, ≥90 days apart. Laboratory-based retention (R LB ) was defined similarly, using the dates of CD4-positive cell counts or HIV-1 RNA measurements. Percentage of agreement and the κ statistic were used to characterize agreement between R LB and R EB . Logistic regression with generalized estimating equations and stabilized inverse-probability-of-selection weights was used to elucidate temporal trends and the discriminatory power of R LB as a predictor of R EB , accounting for age, sex, race/ethnicity, primary HIV risk factor, and cohort site as potential confounders. Both R EB and R LB increased from 2000 to 2010 (from 67% to 78% and from 65% to 77%, respectively), though R EB was higher than R LB throughout (P < 0.01). R LB agreed well with R EB (80%-86% agreement; κ = 0.55-0.62, P < 0.01) and had a strong, imperfect ability to discriminate between persons retained and not retained in care by R EB (C statistic: C = 0.81, P < 0.05). As a proxy for R EB , R LB had a sensitivity and specificity of 84% and 77%, respectively, with misclassification error of 18%. clinical encounters; clinical retention; HIV; laboratory measurements; measurement error; misclassification; proxies Abbreviations: AIDS, acquired immunodeficiency syndrome; CI, confidence interval; HIV, human immunodeficiency virus; HIV-1, HIV type 1; IDU, injection drug user; IPW, inverse-probability-of-selection weights; NA-ACCORD, North American AIDS Cohort Collaboration on Research and Design; ROC, receiver operating characteristic; ROR, ratio of odds ratios.Access to health care and its utilization for clinical monitoring in both healthy populations (for preventive care) and unhealthy populations (for treatment) are vital components of improving health outcomes. The reliable and ongoing use of clinical services by patients as part of disease management, or retention in care, is one such indicator of health-care utilization. Epidemiologic tools have long been recognized as being both available and useful for evaluation of evidence and formulation of policies for health services (1). With healthcare reform (e.g., the Affordable Care Act) removing barriers to linkage to care in the United States, an understanding of how people seek health care and are retained in care is likely to become increasingly valuable (2, 3). These questions speak to identifying disparities in our health-care system and may have a large impact on patient outcomes.The study of...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Rebeiro¹,

Althoff²,

Lau³

et al. 2015

Am. J. Epidemiol.

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“…Current therapy guidelines (Department of Health and Human Services [DHHS]) for HIV-1 state that virologic failure occurs when the viral load exceeds 200 cps/ml, and as such, a physician would need to confirm this change in the viral load with a subsequent viral load measurement (22)(23)(24)(25). An abrupt rise in the viral load may simply indicate a "viral blip"-a temporary rise that will resolve itself or an actual change in the patient's status (virologic failure).…”

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confidence: 99%

Sigma Metrics for Assessing Accuracy of Molecular Testing

Westgard

Lucic

2015

Clinical Microbiology Newsletter

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“…This surveillance supplemental report complements the 2013 HIV Surveillance Report [6] and presents the results of focused analyses of National HIV Surveillance System (NHSS) [7] and Medical Monitoring Project (MMP) [8][9][10] data to measure progress toward achieving selected objectives of the NHAS and the DHAP Strategic Plan. Data in this report are also used to assess key Department of Health and Human Services core indicators [11,12] and monitor progress toward attainment of HIV-related national objectives in Healthy People 2020 [5]. Objectives measured in this report include the following:…”

Section: Commentarymentioning

confidence: 99%

Conjoint Treatment: A Novel Approach to Target the Syndemic Conditions of Trauma, Substance Abuse, and HIV in Women Living with HIV

Pellecchia¹,

Roeschlein²,

Lewis³

et al. 2017

Southern Medical Journal

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Measuring What Matters: Development of Standard HIV Core Indicators across the U.S. Department of Health and Human Services

Cited by 66 publications

References 9 publications

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Sigma Metrics for Assessing Accuracy of Molecular Testing

Conjoint Treatment: A Novel Approach to Target the Syndemic Conditions of Trauma, Substance Abuse, and HIV in Women Living with HIV

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