Comparative value of four measures of retention in expert care in predicting clinical outcomes and health care utilization in HIV patients

Kelly R. Reveles, Timothy R. Juday, Matthew J. Labreche, Eric M. Mortensen, Jim M. Koeller, Daniel Seekins, Christine U. Oramasionwu, Mary Bollinger, Laurel A. Copeland, Xavier Jones, Christopher R. Frei

Research output: Contribution to journalArticle

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Abstract

This study compared the ability of four measures of patient retention in HIV expert care to predict clinical outcomes. This retrospective study examined Veterans Health Administration (VHA) beneficiaries with HIV (ICD-9-CM codes 042 or V08) receiving expert care (defined as HIV-1 RNA viral load and CD4 cell count tests occurring within one week of each other) at VHA facilities from October 1, 2006, to September 30, 2008. Patients were ≥18 years old and continuous VHA users for at least 24 months after entry into expert care. Retention measures included: Annual Appointments (≥2 appointments annually at least 60 days apart), Missed Appointments (missed ≥25% of appointments), Infrequent Appointments (>6 months without an appointment), and Missed or Infrequent Appointments (missed ≥25% of appointments or >6 months without an appointment). Multivariable nominal logistic regression models were used to determine associations between retention measures and outcomes. Overall, 8,845 patients met study criteria. At baseline, 64% of patients were virologically suppressed and 37% had a CD4 cell count >500 cells/mm3. At 24 months, 82% were virologically suppressed and 46% had a CD4 cell count >500 cells/mm3. During follow-up, 13% progressed to AIDS, 48% visited the emergency department (ED), 28% were hospitalized, and 0.3% died. All four retention measures were associated with virologic suppression and antiretroviral therapy initiation at 24 months follow-up. Annual Appointments correlated positively with CD4 cell count >500 cells/mm3. Missed Appointments was predictive of all primary and secondary outcomes, including CD4 cell count ≤500 cells/mm3, progression to AIDS, ED visit, and hospitalization. Missed Appointments was the only measure to predict all primary and secondary outcomes. This finding could be useful to health care providers and public health organizations as they seek ways to optimize the health of HIV patients.

Original languageEnglish (US)
Article numbere0120953
JournalPLoS One
Volume10
Issue number3
DOIs
StatePublished - Mar 20 2015

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Patient Acceptance of Health Care
Health care
health services
Appointments and Schedules
Health
HIV
veterans
CD4 Lymphocyte Count
cells
Veterans Health
United States Department of Veterans Affairs
Viral RNA
Public health
Logistics
Hospital Emergency Service
Acquired Immunodeficiency Syndrome
Logistic Models
health care workers
viral load
Human immunodeficiency virus 1

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Comparative value of four measures of retention in expert care in predicting clinical outcomes and health care utilization in HIV patients. / Reveles, Kelly R.; Juday, Timothy R.; Labreche, Matthew J.; Mortensen, Eric M.; Koeller, Jim M.; Seekins, Daniel; Oramasionwu, Christine U.; Bollinger, Mary; Copeland, Laurel A.; Jones, Xavier; Frei, Christopher R.

In: PLoS One, Vol. 10, No. 3, e0120953, 20.03.2015.

Research output: Contribution to journalArticle

Reveles, KR, Juday, TR, Labreche, MJ, Mortensen, EM, Koeller, JM, Seekins, D, Oramasionwu, CU, Bollinger, M, Copeland, LA, Jones, X & Frei, CR 2015, 'Comparative value of four measures of retention in expert care in predicting clinical outcomes and health care utilization in HIV patients', PLoS One, vol. 10, no. 3, e0120953. https://doi.org/10.1371/journal.pone.0120953
Reveles, Kelly R. ; Juday, Timothy R. ; Labreche, Matthew J. ; Mortensen, Eric M. ; Koeller, Jim M. ; Seekins, Daniel ; Oramasionwu, Christine U. ; Bollinger, Mary ; Copeland, Laurel A. ; Jones, Xavier ; Frei, Christopher R. / Comparative value of four measures of retention in expert care in predicting clinical outcomes and health care utilization in HIV patients. In: PLoS One. 2015 ; Vol. 10, No. 3.
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abstract = "This study compared the ability of four measures of patient retention in HIV expert care to predict clinical outcomes. This retrospective study examined Veterans Health Administration (VHA) beneficiaries with HIV (ICD-9-CM codes 042 or V08) receiving expert care (defined as HIV-1 RNA viral load and CD4 cell count tests occurring within one week of each other) at VHA facilities from October 1, 2006, to September 30, 2008. Patients were ≥18 years old and continuous VHA users for at least 24 months after entry into expert care. Retention measures included: Annual Appointments (≥2 appointments annually at least 60 days apart), Missed Appointments (missed ≥25{\%} of appointments), Infrequent Appointments (>6 months without an appointment), and Missed or Infrequent Appointments (missed ≥25{\%} of appointments or >6 months without an appointment). Multivariable nominal logistic regression models were used to determine associations between retention measures and outcomes. Overall, 8,845 patients met study criteria. At baseline, 64{\%} of patients were virologically suppressed and 37{\%} had a CD4 cell count >500 cells/mm3. At 24 months, 82{\%} were virologically suppressed and 46{\%} had a CD4 cell count >500 cells/mm3. During follow-up, 13{\%} progressed to AIDS, 48{\%} visited the emergency department (ED), 28{\%} were hospitalized, and 0.3{\%} died. All four retention measures were associated with virologic suppression and antiretroviral therapy initiation at 24 months follow-up. Annual Appointments correlated positively with CD4 cell count >500 cells/mm3. Missed Appointments was predictive of all primary and secondary outcomes, including CD4 cell count ≤500 cells/mm3, progression to AIDS, ED visit, and hospitalization. Missed Appointments was the only measure to predict all primary and secondary outcomes. This finding could be useful to health care providers and public health organizations as they seek ways to optimize the health of HIV patients.",
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