Delivering High-Quality HIV Care in the South: System-Level Policy Alternatives

项目摘要 虽然艾滋病毒的临床护理已经取得了巨大的进步，但美国大多数艾滋病毒感染者 没有得到循证护理，使他们能够充分延长生命和改善健康。缺乏 有效的艾滋病护理在南部地区尤其成问题，南部地区是美国艾滋病流行的中心， 贫困、无保险、农村化和有限的卫生人力进一步威胁到有效的医疗保健。 研究表明，系统层面的因素，或卫生保健的结构和政策相关方面， 提供服务，有可能提高护理质量和健康成果。但人们对它们的作用知之甚少 在艾滋病毒护理提供、护理质量和健康结果方面。拟议的研究将研究如何 两个可修改的系统级因素--地理上的医疗可及性和医生支付政策--影响 艾滋病毒护理质量和人口成果，包括艾滋病毒新感染，沿着艾滋病毒护理连续体， 美国南部。由于少数种族和少数民族在艾滋病毒护理方面面临越来越多的障碍， 关注这些系统层面的因素可能如何导致艾滋病毒护理质量和人口的差异 沿着艾滋病毒护理连续体的成果。这项研究涉及开发一个新的数据库， 多个数据源，包括医疗补助行政索赔文件，艾滋病毒监测数据，县和 国家数据集的特征。我们的方法将依赖于最先进的空间网络分析 数据可视化（制图）、使用计量经济学方法的统计检验以及系统科学预测 已用于研究护理质量和人口健康结果的技术。作品移动 除了审查艾滋病毒护理措施的核心质量外，还应包括与艾滋病毒有关的预防性护理措施， 共同对降低艾滋病毒发病率和死亡率至关重要。在调查这些因素时，研究将 回答一些重要的问题。地理可达性如何，以旅行时间来衡量， 护理和医生支付服务影响艾滋病毒护理的质量在南方？这些影响是否不同 种族和少数民族之间？地理可达性的改善或医生人数的增加 在艾滋病护理连续性的沿着，支付减少了新的艾滋病感染和种族和民族差异？的 拟议的研究将解决这些问题和其他问题。通过量化系统级因素在 艾滋病毒护理质量和人口健康沿着艾滋病毒护理连续体，以及了解 这些影响，研究将提供有价值的信息，以国家和联邦政策制定者谁寻求 解决有效艾滋病毒护理的系统性挑战，有效分配稀缺资源，改善公共卫生， 健康

PROJECT SUMMARY While clinical care for HIV has made tremendous advances, the majority of persons living with HIV in the US do not receive the evidence-based care that will allow them to fully extend life and improve health. Lack of effective HIV care is particularly problematic in the Southern region, the epicenter of the US HIV epidemic and where poverty, uninsurance, rurality, and a constrained health workforce further threaten effective care. Research suggests that system-level factors, or the structural and policy-related aspects of health care delivery, have the potential to improve quality of care and health outcomes. But little is known about their role in the context of HIV care delivery, quality of care, and health outcomes. The proposed research will study how two modifiable system-level factors—geographic accessibility to care and physician payment policies—affect quality of HIV care and population outcomes, including new HIV infections, along the HIV care continuum in the US South. Because racial and ethnic minorities face increased barriers to HIV care, we pay special attention to how these system-level factors may contribute to disparities in quality of HIV care and population outcomes along the HIV care continuum. The research involves developing a novel database that combines multiple data sources, including Medicaid administrative claims files, HIV surveillance data, and county and state characteristics from national datasets. Our approach will rely on state-of-the-art spatial network analysis and data visualization (mapping), statistical tests using econometric methods, and systems science forecasting techniques that have been used to study quality of care and population health outcomes. The work moves beyond examination of core quality of HIV care measures to include HIV-related preventive care measures that collectively are critical to reducing HIV morbidity and mortality. In investigating these factors, the study will answer a number of important questions. How do geographic accessibility, measured in travel time to receive care, and physician payment for services affect quality of HIV care in the South? Are these effects different among racial and ethnic minorities? Do improvements in geographic accessibility or increased physician payments reduce new HIV infections and racial and ethnic disparities along the HIV care continuum? The proposed study will address these questions and others. By quantifying the role of system-level factors in quality of HIV care and population health along the HIV care continuum, as well as understanding disparities in these effects, the research will provide valuable information to state and federal policy makers who seek to address systemic challenges to effective HIV care, efficiently allocate scarce resources, and improve public health.