Aging, comorbid conditions, and health care utilization in persons with HIV

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DESCRIPTION: Patients with HIV are experiencing higher than expected rates of Non-AIDS (HANA) conditions as they age that contribute to premature morbidity and mortality. An important barrier to improving these outcomes is that there are no nationally generalizable data showing how HANA conditions disease impact rates of burdensome and costly health care utilization (e.g. recurrent hospitalization), and how this changes with aging. Addressing this barrier will permit the development of evidence-based clinical interventions and facilitate policy planning. The long term goal of this research is to reduce unnecessary and costly health care utilization and institutionalization for aging persons with HIV. The objective of this application, the first step toward this long term goal, is to understand how age and selected HANA conditions (diabetes, cardiovascular disease, liver disease, pulmonary disease, and psychiatric disease) interact to affect key health care utilization events. We propose to study a 14-state, nationally representative, sample of Medicaid patients, and for those admitted to a nursing home, link the Medicaid files to nursing home Minimum Data Set (MDS). The central hypothesis of this proposal is that these HANA conditions may accelerate or accentuate frailty and functional decline, producing premature and burdensome utilization and institutionalization. The rationale for this hypothesis is that aging in persons with HIV has been associated with higher rates of chronic conditions and higher mortality than control population, but no literature that we are aware of examines the kind of care utilization that frailty and functional decline produces, or quantifies the effects of age and comorbidity on this utilization. This proposal is relevant to the NIH's mission because it seeks to reduce the burdens of illness and disability for a growing group - persons aging with HIV. This study has three Specific Aims: 1) Describe the prevalence and incidence of the selected co-morbid conditions in HIV+ persons, and describe how incidence and prevalence vary with chronologic age; 2) Calculate the rate of burdensome health care utilization, nursing home use, and permanent nursing home placement as a function of chronologic age in HIV+ persons, and show how this relationship changes with the presence of the selected co-morbid conditions; and 3) Calculate the rate of functional and cognitive decline among HIV+ nursing home residents as a function of chronological age, and show how this relationship changes with the presence of the selected co-morbid conditions. This approach is innovative because we use a nationally representative sample, employ methods and approaches from health services research not previously applied to aging and HIV, link Medicaid and MDS data, and develop new analytic tools to study burdensome service utilization in Medicaid patients with HIV. The approach is significant because it can generate hypotheses about biological mechanisms in aging that can guide future work, and also because state and federal policy makers need such data to plan for future care needs. The evidence from this project will lay the groundwork for future analyses of quality and costs of care for aging patients with HIV.