Mortality among clients in the New York city HIV Care Coordination Program (CCP): incidence and associated clinical factors.
Mortality among clients in the New York city HIV Care Coordination Program (CCP): incidence and associated clinical factors.
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DOI：
10.1016/j.annepidem.2021.10.001
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发表时间：
2021-12
影响因子：
5.6
通讯作者：
Nash D
中科院分区：
文献类型：
--
作者：
Robertson MM;Irvine MK;Penrose K;Harriman G;Braunstein SL;Nash D
我们检查了与全因和HIV相关死亡率相关的社会心理因素（住房、药物使用、监禁史或精神健康）和护理因素（合并症和急性护理），同时纳入了纽约市Ryan White HIV护理协调计划（CCP），这是一个针对HIV护理和治疗障碍人群的强化病例管理计划。我们使用风险回归（HR）来了解与死亡率相关的因素。从2011年3月到2016年12月，共8135人（13479.4人年[PY]）在中共注册。登记期间的全因死亡率为28.8 / 1000日元（N=388），其中43%的死亡（N=167）与艾滋病毒有关（12.4 / 1000日元）。控制人口统计学和临床状况，与全因死亡率风险增加相关的变量包括入组前的住院或急诊就诊（ahr住院：2.54；95%置信区间2.07-3.11,aHRED: 1.54; 1.24-1.92）或入组时的糖尿病或丙型肝炎诊断（ahr糖尿病：1.80;1.36-2.37,aHRHCV: 1.78; 1.37-2.30）。这些因素也增加了艾滋病毒相关死亡的危险。CCP和类似的病例管理程序应系统地筛选入组患者的急性护理史和合并症，因为它们可能是需要更密集的参与和随访以预防死亡的重要标志。急性护理使用史或糖尿病或丙型肝炎诊断可用于系统筛选和识别CCP或其他病例管理入组者，需要更密切的随访或更密集和及时的支持。这些发现强调了将初级和专科护理与社会服务相结合的模式对于制定以客户为中心的服务计划的重要性。
We examined psychosocial factors (housing, drug use, incarceration history or mental health) and care factors (comorbidities and acute care) associated with all-cause and HIV-related mortality while enrolled in the New York City Ryan White HIV Care Coordination Program (CCP), an intensive case management program for people with barriers to HIV care and treatment. We used hazards regression (HR) to understand factors associated with mortality. 8,135 people (13,479.4 person years [PY]) enrolled in the CCP from March 2011 to December 2016. The all-cause mortality rate while enrolled was 28.8 per 1000 PY (N=388), with 43% of deaths (N=167) related to HIV (12.4 per 1000 PY). Controlling for demographics and clinical status, the variables associated with increased hazards of all-cause mortality included hospitalizations or emergency-department visits prior to enrollment (aHRHospitalizations: 2.54; 95% Confidence Interval 2.07–3.11 and aHRED: 1.54; 1.24–1.92) or a diabetes or Hepatitis C diagnosis at enrollment (aHRDiabetes: 1.80; 1.36–2.37 and aHRHCV: 1.78; 1.37–2.30). These factors also increased the hazards of HIV-related mortality. CCP and similar case management programs should systematically screen enrolling clients for a history of acute care and comorbidities, as they may be important markers of need for more intensive engagement and follow-up to prevent death. A history of acute care utilization or a diabetes or Hepatitis C diagnosis may be used to systematically screen and identify CCP or other case-management enrollees in need of closer follow-up or more intensive and timely support. These findings highlight the importance of models integrating primary and specialty care with social services for developing client-centered service plans.
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