QUALITY AND COST OF CARE FOR HIV+ MEDICAID PATIENTS

艾滋病毒疾病的发病率和流行率持续上升 在相关的资源和培训需求方面开始出现严重的 对许多州的医疗补助计划的影响，这些计划为 高达60%的艾滋病患者(PWAS)。临床研究已经确定 齐多夫定、五烷双胺等药剂的疗效 为了提高存活率和降低机会主义的风险 感染。然而，人们对其质量、成本和总体情况知之甚少 向弱势医疗补助人群提供的医疗保健模式 作为低收入妇女和患有艾滋病毒的儿童，特别是那些 在主流医疗系统之外，他们可能没有足够的 在以前的研究中有代表性。这样的信息可能是有用的 在针对和实施质量改进计划以纠正 特定患者和医生群体在护理质量方面的差距。 我们将把新泽西州的医疗补助资格和索赔数据与 新泽西州卫生部艾滋病监测数据 1987年至1991年期间的登记情况。我们用以下方法验证医疗补助艾滋病数据 来自注册处的信息并确定敏感度和 我们基于医疗补助的身份识别过程的特殊性。致我们的 知识，这将是最大的关联医疗补助-艾滋病注册 美国感染艾滋病毒的妇女和儿童的数据库。 我们将定义可用于(1)监控的护理质量指标 随时间推移遵守治疗指南的进展，以及(2)检测 在三个队列之间和之内的护理模式的差异 患者(妇女、儿童和男性静脉吸毒者)和 给医生开处方。我们将检查小学和小学之间的差异 专科和培训以及占主导地位的医生护理员 环境(在私人诊所、药物滥用诊所、门诊医院 诊所等)为低收入、感染艾滋病毒的妇女提供服务 以及他们的子女和成年男性静脉注射吸毒者。vbl.使用 生存分析方法，调查将包括三个方面 阶段：(1)描述患者分组中的护理模式； (2)坚持以科学为基础的临床的趋势和变化 准则，主要侧重于感染艾滋病毒的妇女；(3) 不同患者、医生和医生对HIV感染妇女的治疗差异 设置特征。

The continuing escalation in the incidence and prevalence of HIV disease and in associated resource and training needs is beginning to have severe impacts on many state Medicaid programs, which provide medical care for up to 60% of people with AIDS (PWAs). Clinical research has established the efficacy of pharmaceutical agents such as zidovudine and pentamidine for increasing survival and reducing the risks of opportunistic infections. Yet little is known about the quality, costs, and overall patterns of medical care provided to vulnerable Medicaid populations such as low-income women and children with HIV disease, particularly those outside the mainstream medical care system who may not be adequately represented in previous research studies. Such information can be useful in targeting and implementing quality improvement programs to correct gaps in quality of care in specific patient and physician populations. We will link New Jersey Medicaid eligibility and claims data with surveillance data from the New Jersey Department of Health's AIDS Registry from 1987 to 1991. We validate Medicaid AIDS data with information from the Registry and determine the sensitivity and specificity of our Medicaid-based identification process. To our knowledge, this will be the largest linked Medicaid-AIDS Registry' database on HIV-infected women and children in the U.S. We will define quality of care indicators that can be used to (1) monitor progress in adherence to treatment guidelines over time, and (2) detect variations in patterns of care between and within three cohorts of patients (women, children and male intravenous drug users) and prescribing physicians. We will examine variation among primary physician caregivers in specialty and training and in predominant settings (in private practice, drug abuse clinics, outpatient hospital clinics, etc.) for' services provided to low-income, HIV-infected women and their children and adult, male intravenous drug users. Using survival analysis methodologies, the investigation will encompass three phases: (1) description of patterns of care among the patient subgroups; (2) trends and variation in adherence to scientifically-based clinical guidelines, with a primary focus on HIV-infected women; (3) predictors of variation in treatment of HIV-infected women by patient, physician and setting characteristics.