RESUMEN
As the number of people with HIV/AIDS receiving services in managed care models increases, concerns over quality of care and satisfaction with services have grown. This article examined data from three national demonstration projects that were funded to enroll traditionally underserved individuals and provide innovative medical services in programs developing models appropriate for managed care funding. Assessments of patient satisfaction were related to indicators of traditionally underserved status including demographic characteristics, behaviors, and other risk factors using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Overall patient satisfaction levels with these programs were very high. Through the modeling methods, the groups most likely to experience the greatest program satisfaction are identified. In general, all groups were highly satisfied with the programs.
Asunto(s)
Infecciones por VIH/terapia , Programas Controlados de Atención en Salud/organización & administración , Área sin Atención Médica , Modelos Organizacionales , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Distribución de Chi-Cuadrado , Femenino , Infecciones por VIH/etnología , Humanos , Masculino , Persona de Mediana Edad , Innovación Organizacional , Satisfacción del Paciente/etnología , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Estados UnidosRESUMEN
The demographic, behavior, and background characteristics of 4,804 participants in 17 national demonstration projects for HIV medical and/or psychosocial support services were coded for an index of "service need" or possible under-representation in the traditional healthcare system. Fifteen items were coded including status as a person of color, lack of private insurance, unemployment/disability, problem drinking, crack cocaine use, heroin use, other illicit drug use, less than 12 years of education, criminal justice system involvement, children requiring care while the patient receives services, sex work, being the sex partner of an injection drug user, unstable housing, primary language not English, and age less than 21 or over 55 years. Most (87.7%) of the program participants had four or more of these factors present. Through CHAID modeling, those groups with the highest levels of service need and vulnerability were identified. These data suggest that these projects, designed to attract and serve individuals potentially underrepresented in the health services system, had in fact achieved that goal. Implications of the changing demographics of the HIV epidemic for the health service delivery system are discussed.
Asunto(s)
Servicios de Salud Comunitaria , Infecciones por VIH/terapia , Área sin Atención Médica , Evaluación de Necesidades/clasificación , Adulto , Distribución de Chi-Cuadrado , Demografía , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Apoyo Social , Estados Unidos , Salud de la MujerRESUMEN
As the demographics of the populations of affected individuals have changed, systems of care have needed to adapt to be responsive to client needs. This article examines client satisfaction data from seven national demonstration projects funded to enroll individuals from traditionally underserved groups and help them access services using different strategies. Data on client satisfaction ratings were related to indicators of traditionally underserved status, including demographic characteristics, behaviors, and other risk factors using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Client groups that were most likely to experience relatively higher and lower levels of satisfaction with services are identified. Overall, all client groups were highly satisfied with the innovative HIV/AIDS services received. The findings illustrate the success of these innovative HIV care models in being responsive and sensitive to the needs of their target populations.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Infecciones por VIH/terapia , Área sin Atención Médica , Evaluación de Necesidades/clasificación , Satisfacción del Paciente/estadística & datos numéricos , Servicios de Salud para Estudiantes/organización & administración , Adulto , Distribución de Chi-Cuadrado , Infecciones por VIH/etnología , Humanos , Persona de Mediana Edad , Modelos Organizacionales , Innovación Organizacional , Satisfacción del Paciente/etnología , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Estados Unidos , UniversidadesRESUMEN
This article develops a typology of 2,038 participants in 13 innovative HIV/AIDS treatment model service demonstration projects targeted to traditionally underserved populations. The typology is based on self-reported health-related quality of life levels. Eight clusters were identified that classify HIV/AIDS patients based on their reported health-related quality of life. Participants were clustered based on their overall levels of quality of life, as well as by deficits in specific areas of functioning such as energy level, physical impairment, and role impairment. However, factor analysis suggests that health-related quality of life as perceived by the HIV-positive participants is best represented as a single underlying dimension and an ordering of the types shows that they are consistently related, in the same order, to several criterion measures of impairment. The results suggest that a general categorization of patients with HIV in terms of quality of life is more meaningful than an assessment of the relative areas of impairment. Since the impairment ratings were also self-reported, analyses relating quality of life clusters to actual symptom levels and healthcare utilization are needed. Implications for the assessment of health-related quality of life and the evaluation of service delivery programs for persons living with HIV are discussed.
Asunto(s)
Infecciones por VIH/clasificación , Investigación sobre Servicios de Salud , Calidad de Vida/psicología , Adulto , Recolección de Datos , Femenino , Infecciones por VIH/fisiopatología , Infecciones por VIH/psicología , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Modelos Organizacionales , Innovación Organizacional , Atención Dirigida al Paciente , Proyectos Piloto , AutoeficaciaRESUMEN
This article explores the relationships of HIV risk factors, service needs, and vulnerabilities to health-related quality of life in a sample of 1,371 participants newly enrolled into 13 innovative HIV/AIDS treatment model service demonstration projects. These projects targeted services to traditionally underserved populations. Eight distinct quality of life clusters of HIV patients were used in this analysis along with patient self-identified risk factors. The quality of life clusters were based on patient self-reported quality of life dimensions. The eight clusters were differentiated based on relative strengths and weaknesses in physical functioning, energy levels, and social functioning. Data on patient need-vulnerability factors and demographic characteristics were related to these eight clusters using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Through this method, the characteristics most likely to be associated with higher and lower levels of quality of life at the time of enrollment into services were identified. The results provide further support that quality of life assessment is a useful clinical tool for monitoring patient progress.
Asunto(s)
Infecciones por VIH/fisiopatología , Infecciones por VIH/psicología , Necesidades y Demandas de Servicios de Salud , Calidad de Vida/psicología , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Empleo , Humanos , Persona de Mediana Edad , Modelos Organizacionales , Atención Dirigida al Paciente , Proyectos Piloto , Factores de Riesgo , Autoeficacia , Estados UnidosRESUMEN
Current terminal care services present dying patients and their families with a dichotomy in service delivery and the intent care between curative treatments and palliative treatments. This arbitrary dichotomy reduces patients' quality of life in many cases and robs patients and families of benefiting from the psychosocial aspects of treatment until the last few weeks of life. This article presents a blended model of care, the Transprofessional Model, in which patients receive both curative and palliative service throughout their care process. The blended intent model differs from traditional home care in that services are provided by a care coordination team composed of nurses and social workers; the traditional model of care is often case managed by a single, registered nurse. The combination of the multi-disciplinary approach to care coordination and training in both curative and palliative services in the Transprofessional Model demonstrates that this blended model of care produces a bio-psychosocial focus to terminal care as compared to a primary focus on curative services present in the traditional model of home care.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Modelos Organizacionales , Cuidado Terminal/organización & administración , Cuidadores/educación , Continuidad de la Atención al Paciente/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados Paliativos al Final de la Vida/organización & administración , Humanos , Capacitación en Servicio , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente , Apoyo Social , Estados UnidosRESUMEN
OBJECTIVE: To determine if a Transprofessional care-management approach (experimental group) produces savings in service delivery dollars when compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active, medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRINCIPLE FINDINGS: Post-test measures indicate an 8 percent reduction in labor delivery costs for an average experimental patient's entire episode of home-care versus for an average control patient's. CONCLUSIONS: An integrated model of service delivery, which is based on interdiscriplinary, care-management and blended modalities of service, provides a cost-effective method in the provision of home-care services for terminally ill AIDS patients.
Asunto(s)
Infecciones por VIH/terapia , Servicios de Atención de Salud a Domicilio/organización & administración , Modelos Organizacionales , Evaluación de Programas y Proyectos de Salud , Adulto , Anciano , Anciano de 80 o más Años , Cognición , Enfermería en Salud Comunitaria/economía , Enfermería en Salud Comunitaria/organización & administración , Enfermería en Salud Comunitaria/normas , Ahorro de Costo , Recolección de Datos , Femenino , Infecciones por VIH/fisiopatología , Investigación sobre Servicios de Salud , Salud Holística , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/normas , Humanos , Los Angeles , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To determine the relationship among 11 types of home health care services for patients with HIV/AIDS and to develop a terminal-care, service-usage profile of persons receiving such services. Services include the number of psychiatric nurse visits, Medical Social Work (MSW) visits, evaluation visits, physical therapy visits, occupational therapy visits, homemaker visits, home health aide visits, public health nurse visits, registered nurse (RN) visits, Licensed Vocational Nurse (LVN) visits, and Intravenous (i.v.) nurse visits. DATA SOURCES AND STUDY SETTING: Data were collected on 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). The service utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: The relationship among the service types was evaluated with principal component analysis. A service-usage profile was developed for patients using cluster analysis. To control for the variability in the amount of time that patients were on service, the number of days that patients were in the VNA-LA program and were actually receiving services was included as a factor that yielded a variable reflecting the number of each type of service that a patient received per day. PRINCIPAL FINDINGS: Five components were found to best describe the relationships among the service-type variables. These were identified as being: the Number of Evaluation Visits, the Number of Intensive Nursing Visits, the Number of Physical Therapy Visits, the Number of Psychosocial Visits, and the Number of Attendant Visits. Patients were found to cluster into 1 of 5 groups based on the type of service utilization profile that they received. The variables that appeared to have the most influence on this profile were the number of home health aide visits per day that the patient received, the number of RN visits that were made, the number of i.v. nurse visits that were provided, and the number of LVN visits that were made. CONCLUSIONS: Terminally ill AIDS patients receiving home health care services can be identified as having a service utilization profile. This profile can be used to evaluate more precisely the service areas in which costs for patient services differ. Individually assigned to an experimental Transprofessional Model of care had a different service utilization profile than those assigned to a Traditional Model of care.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Servicios de Atención de Salud a Domicilio/organización & administración , Modelos Organizacionales , Cuidado Terminal/organización & administración , Análisis por Conglomerados , Enfermería en Salud Comunitaria/organización & administración , Atención Integral de Salud/organización & administración , Demografía , Femenino , Investigación sobre Servicios de Salud , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Los Angeles , Masculino , Apoyo Social , Cuidado Terminal/estadística & datos numéricosRESUMEN
OBJECTIVE: To determine if a Transprofessional, care-management approach (experimental group) produces different patterns of retention in home treatment as compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). Initially, the Transprofessional Model should lead to a greater retention rate in the program as patients bond to blended care managers, but in later stages clients needing hospice should be moved off-services resulting in lower retention rates in the medical-surgical home care venue. DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRIMARY FINDING: In the earliest stages, Transprofessional patients tend to be more likely to stay in treatment, probably due to the greater bonding to the program. After about one year, the Transprofessional patients are more likely to leave the program as they are transitioned into hospice care. CONCLUSIONS: An integrated model of service delivery, which is based on interdisciplinary care-management and blended modalities of service, provides a quality of life enhancing and a cost-effective method in the provision of home-care services for terminally ill AIDS patients.