17th Texas HIV/STD ConferenceAustin, Texas

May 2010

AIDS Arms Inc/Peabody Health CenterDallas, Texas

BACKGROUNDThe Health Resources and Services

Administration HIV/AIDS Bureau (HAB) recently established clinical indicators of performance for Ryan White grantees starting in 2010.

These indicators give HAB and the individual program the ability to better assess the level of clinical care being provided.

Rawlings 17th TX HIV/STD Conference

OBJECTIVESTo determine the current level of adherence

to the HAB indicators in our setting, and any demographic differences in achieving them.

Rawlings 17th TX HIV/STD Conference

METHODSA retrospective review of medical records and

electronic databases on all patients seen at the Peabody Health Center between January 1, 2009 and October 31, 2009.

Demographic information (age, gender and race), dates of medical visits, and dates and value of CD4 cell counts were collected on all patients.

Pharmaceutical information was abstracted to determine if HAART or PCP prophylaxis was prescribed during the study period.

Rawlings 17th TX HIV/STD Conference

RESULTSFour HAB clinical indicators where reviewed

over the 10 month period. A total of 846 unique patients received 4400

ambulatory medical and laboratory visits. The overall population was:

80.9% males, 52.4% Black, 29.9% White, and 17.7% Hispanic.

69.1% were between the ages of 30 and 50.

Rawlings 17th TX HIV/STD Conference

RESULTSAll patients had >1 CD4 cell count drawn. Only 140 (16.6%) of the patients had a CD4

count <200 cells/mm3. There was no difference in outcomes based

on the type of provider (MD or NP).

Rawlings 17th TX HIV/STD Conference

RESULTSOverall percentage of patients met the

criteria for:Medical visit frequency (73.5%)CD4 frequency (68.7%)PCP prophylaxis (77.9%) and Prescribed HAART (83.6%).

Rawlings 17th TX HIV/STD Conference

RESULTSINDICATORS MET AGE RACE/ETHNICITY GENDER

<30 30-50 >50 Black White Hispanic Male Female

>2 medical visits 3 months apart 68.7% 72.7% * 82.7% 74.5% 68.7% 78.7% 72.0% 80.1%

>2 CD4 counts 3 months apart 59.7% 68.7% * 78.0% 68.6% 64.4% 76.0% 68.8% 68.3%

CD4 <200 prescribed PCP Prophylaxis 87.5% 75.5% 80.8% 77. 8% 75.0% 82.1% 75.2% 91.3%

CD4 < 200 prescribed HAART 75.0% 82.7% * 92.3% 84.7% 80.0% 85.7% 82.9% 87.0%

* p<0.05

Rawlings 17th TX HIV/STD Conference

CONCLUSIONSThe data suggest that there is room for

improvement in meeting the HAB indicators.There is no difference in achieving the indicators

based on race/ethnicity.Compared to those <30 years old, patients age

>50 were significantly more likely to meet the indicators for frequency of CD4 count and medical visits, along with being prescribed HAART.

A greater percentage of females were prescribed PCP prophylaxis and kept appointments then males.

Rawlings 17th TX HIV/STD Conference

IMPLICATIONSResearch is needed to determine what about

patients >50 could be used to improve outcomes among those in the <30 age group.

Gender differences in indicator outcomes also call for further evaluation.

Rawlings 17th TX HIV/STD Conference