VA QUERI/HIV

VA QUERI-HIV Ongoing Projects

The QUERI HIV has developed a rich and complex portfolio over it short life. All currently funded or completed projects are listed below.

All QUERI-HIV projects address QUERI's steps model.

1. ID high-risk high-volume diseases or problems.
2. ID best practices.
3. Define existing practice patterns and outcomes and variation from best practices.
4. ID and implement interventions to promote best practices.
5. Document that best practices improve outcomes.
6. Document that outcomes are associated with improved health-related quality of life."

The QUERI HIV has developed a rich and complex portfolio over it short life. All currently funded or completed projects are listed below:

a. QUERI A- Improving the HIV/AIDS Immunology Case Registry.
The product of this project is the Heart and Soul of the QUERI HIV.
HIV Quality Enhancement Research Database (QED)- comprehensive research database of VA HIV patient information.
.

QED Document 1 ( Final Short )

QED Document 2 ( Final Append )

RDU

b.      QUERI B- Supplemental Data Collection for Veterans with HIV/AIDS:
Survey and Chart Review.
This survey's data will augment the HIV-QED with health-related quality of life, out-of-VA care, and patient satisfaction information.

c.      QUERI C- Measuring HIV Quality of Care/ Improving HIV Care Quality.
This project tested methods for improving quality of HIV care in ARV medications and opportunistic infections screening and prophylaxis. Reports detail the effectiveness of the interventions and provide valuable information for future translation projects in the VA system.

d.     IIRs- Investigator initiated research projects.
i.      Terry Menke- Described determinants of adherence to antiretroviral therapy and impact on outcomes.
ii.     Douglas Owens: Identification of HIV-infected veterans.
iii.    Allen Gifford: Adherence study.

e. The Risk of Cardiovascular and Cerebrovascular Events in HIV Patients on HAART. Part I. Project studied the impact of HAART on cardiovascular and cerebrovascular events , especially on regimens that include protease inhibitors.

New projects in the work


Working Group / Theme	PI/ research site	PI/ research site Topics/ Objectives

Antiretroviral Drug Resistance Testing	Matthew Goetz, MD VA Greater Los Angeles Healthcare System	Overall goal of this project is to improve ordering, interpretation, and use of anti-retroviral resistance tests in the management of HIV-infected patients, according to recommended care.

Improving Adherence to HIV Clinic Appointments	Allen Gifford, MD VA San Diego Healthcare System Thomas Giordano, MD VA Houston Medical Center	• Conduct formative assessments of appointment-keeping interventions already tried or ongoing within the VA HIV clinics; •Implement and evaluate an (i) optimized automated reminder system, (ii) a telephone prompting and problem-solving system, and the interaction of the two, in reducing no-show rates, improving clinic attendance, and improving cost-efficiency of care compared with usual clinic procedures; • Recommend cost-efficient appointment-keeping intervention and implementation strategies for dissemination throughout the VA.

Improving HIV Screening with Rapid Testing and Streamlined Counseling	Steve Asch, MD, MPH VA West Los Angeles Medical Center Douglas Owens, MD, MSc VA Palo Alto Healthcare System	• Overall goal of the project is to test independent effects of streamlined counseling and rapid HIV testing on patient knowledge and rates of HIV screening in general medicine clinics.

Evaluating HIV/AIDS Care Access and Quality in the VA	Samuel Bozzette, MD, PhD VA San Diego Healthcare System	•To demonstrate that the current ICR capture mechanism misses true HIV cases, results in some false positive cases; and that a case-finding algorithm based on ICD-9 CM codes and antiretroviral prescription fills offers a mechanism for more complete and accurate identification of true HIV cases. •To identify individual and structural characteristics that are predictive of identification on the ICR; and • To demonstrate that ICR capture is an important determinant of HIV care access and, therefore, care quality.

The Risk of Cardiovascular and Cerebrovascular Events in HIV Patients on HAART (Highly Active Antiretroviral Therapy) Part II	Samuel Bozzette, MD, PhD VA San Diego Healthcare System	•To study the impact of HAART on cardiovascular and cerebrovascular events, especially on regimens that include protease inhibitors