HIV Care in US Nursing Homes

Northeastern University, Boston MA

Investigators

Linked publications, trials & patents

Abstract

PROJECT SUMMARY/ABSTRACT Approximately half of the 1.2 million individuals living in the US with human immunodeficiency virus (HIV) are currently over the age of 50. Due to breakthroughs in antiretroviral therapies, older people living with HIV (PLWH) can now expect a similar life-course of events as other elders, including needing nursing home (NH) care for age-related disabilities and dementias. However, older adults with HIV may have unique needs in the NH setting including requiring routine access to antiretroviral therapies, regular blood tests and vaccinations. The National Quality Forum (NQF) has recommended 8 quality of care measures for HIV care regardless of clinical settings, however the application of these measures in NHs is unknown. A recent study by the Agency for Healthcare Research and Quality reported that the primary diagnoses for most hospitalizations of PLWH were similar to non-HIV hospitalized patients and the Office of the Inspector General and CMS reports that NHs with low CMS Five-Star Quality Rating values had higher rates of hospitalizations; the risk of hospitalizations in the context of HIV quality of care measures is not known in the NH setting. The purpose of this study is to characterize the current HIV population in NHs and describe the quality of HIV care provided in NHs. The last comprehensive study of the HIV population in NHs was conducted almost 15 years ago when NHs were primarily used for palliative HIV care. Our study will leverage an existing NIH-sponsored database of 2.7 million NH residents and their Medicare claims, Minimum Datasets of NH resident care plans and an all-payer prescription drug dispensing database. We propose to provide an updated characterization (demographics, physical and mental profiles) of the HIV population in NHs, calculate the compliance rates with HIV quality of care measures, and explore the association of HIV care quality with the risk of hospitalization. This innovative and significant research will inform the Medicare program, policy makers, and NH providers of this growing segment of the NH population and provide benchmark metrics that can be used to improve and monitor HIV care in NHs.