COMPARATIVE VALUE OF FOUR MEASURES OF RETENTION IN EXPERT CARE IN PREDICTING CLINICAL OUTCOMES AND HEALTH CARE UTILIZATION IN HIV PATIENTS
Author(s)
Frei CR*1;Juday TR2;Jones X3;Labreche MJ4;Koeller JM1;Hebden T2;Seekins DW2;Oramasionwu CU5;Bollinger M3;Copeland LA6;Teshome B1, Mortensen EM7
1The University of Texas at Austin and The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA, 2Bristol-Myers Squibb Company, Plainsboro, NJ, USA, 3South Texas Veterans Health Care System, Audie L. Murphy Division, VERDICT Research Program, San Antonio, TX, USA, 4The Johns Hopkins Hospital, Baltimore, MD, USA, 5University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 6Central Texas Veterans Health Care System jointly with Scott & White Healthcare, Center for Applied Health Research, Temple, TX, USA, 7The VA North Texas Health Care System and The University of Texas Southwestern Medical Center, Dallas, TX, USA
OBJECTIVES: To compare the ability of four measures of patient retention in HIV expert care to predict clinical outcomes and health care utilization over 24 months. METHODS: This retrospective study examined Veterans Health Administration (VHA) beneficiaries with HIV (ICD-9-CM codes 042 or V08) receiving expert care (HIV-1 RNA and CD4 tests within 1 week of each other) at VHA facilities from October 1, 2006 to September 30, 2008. Patients were 18-89 years old with ≥24 months of VHA eligibility. Retention measures included: “appointments annual” (≥2 appointments annually at least 60 days apart), “appointments missed” (missed ≥25% of appointments), “appointments infrequent” (≥6 months without an appointment), and “appointments missed or infrequent” (missed ≥25% of appointments or ≥6 months without an appointment). Outcomes included: virologic suppression (HIV-1 RNA <500), CD4+ >500, development of an HIV-related condition, progression to AIDS, emergency room (ER) use, and hospitalization. Multivariable regression was used to determine associations between retention measures and outcomes. RESULTS: Study subjects (n=8,845) had a mean age of 52 years and 97% were male; 51% were black, 34% white, 11% other, and 4% unknown. At baseline, 64% of patients were virologically suppressed and 37% had a CD4+ >500. At 24 months, 82% were virologically suppressed and 46% had a CD4+ >500. During follow-up, 42% developed an HIV-related condition, 13.0% progressed to AIDS, 0.3% died, 48% visited the ER, and 28% were hospitalized. All four retention measures were associated with virologic suppression at 24 months. In addition, “appointments annual” was predictive of CD4+ >500 and “appointments missed” was associated with CD4+ >500, development of an HIV-related condition, progression to AIDS, ER use, and hospitalization. CONCLUSIONS: While all four retention measures had clinical value, “appointments missed” was the most accurate predictor of clinical outcomes and health care utilization at 24 months among VHA patients in HIV expert care.
Conference/Value in Health Info
2013-05, ISPOR 2013, New Orleans, LA, USA
Value in Health, Vol. 16, No. 3 (May 2013)
Code
PHS2
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Infectious Disease (non-vaccine)
Explore Related HEOR by Topic
