Institute for Healthcare Improvement: Implement More Frequent and Targeted Performance Measurement

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Improve Antiretroviral (ARV) Management for HIV-Infected Patients:

Implement More Frequent and Targeted Performance Measurement

A patient's response to medication is highly variable and complex. Missing even a few doses of highly active antiretroviral (ARV) drugs can lead to an increase in viral replication and potentially to drug resistance and treatment failure. Clinical providers need up-to-date information to determine the extent of HIV viral suppression, to avoid drug resistance, and to deal with side effects. Use key performance measures to routinely monitor lab values, medication regimens, and opportunistic infections of all patients on antiretroviral (ARV) therapy, particularly for clinically unstable patients.

Tips

Conduct random and routine reviews of patients on ARV therapy to ensure appropriate ARV management.
Conduct focused reviews of patients with viral loads of more than 1,000 cc/mm³ to determine appropriate HIV care management.
Establish routine review of specific cases by a medical director or other senior medical leader.
Perform peer reviews of clinically unstable patients and discuss findings in staff meetings.
Develop additional indicators to measure care of clinically unstable patients on ARV to address specific care issues.
Review treatment plans for certain patient populations.
Establish multidisciplinary quality of care review teams based on agreed upon indicators.

Use electronic medical record (EMR) data to monitor essential elements of ARV management.

Tools

Promoting Adherence to HIV Antiretroviral Therapy

Measuring Clinical Performance: A Guide for HIV Health Care Providers



Improve Antiretroviral (ARV) Management for HIV-Infected Patients Percent of Patients/Clients with Viral Load Test in the Past 4 Months Percent of Patients/Clients with a CD4 Count Test in the Past 4 Months

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