HIV / AIDS
PRHI’s work with HIV/AIDS has focused on clarifying data behind this complex patient population. According to the Centers for Disease Control and Prevention, approximately 0.4% of Americans (or 1.2 million people) are estimated to be living with HIV. However, despite the relatively small proportion of Americans, HIV-positive individuals are high utilizers of the healthcare system. Hospitalizations disrupt the life of the patient (and carry with them their own risks); moreover, they represent large and potentially avoidable expenditures in our healthcare system. The Jewish Healthcare Foundation, administrator of the Ryan White AIDS funds in Southwestern PA, has worked with the PRHI research team to analyze data made available by the Pennsylvania Health Care Cost Containment Council (PHC4) on the characteristics of hospital admissions among HIV patients in southwestern Pennsylvania to identify opportunities for improving care and reducing avoidable readmissions.
The analysis focused on patterns of readmissions in the presence of common primary and secondary diagnoses, as well as the prevalence of comorbid behavioral health conditions. The picture that emerged was one of extraordinarily complex patients, with conditions ranging from HIV-related infections to common chronic diseases, to the side effects of mental illness and drug abuse and of the medications used to treat HIV itself.
The data indicated that one in four HIV- positive individuals admitted to a hospital in southwestern Pennsylvania are readmitted within 30 days, approximately 50% greater than the regional population as a whole. Literature provides evidence that comprehensive primary care, including patient education and care management, can significantly reduce hospital readmissions. While Ryan White funding enables providers to offer many of these services, providers still find it challenging to find the time to consistently implement these best practices.
This data-driven approach has shaped PRHI’s work with the HIV/AIDS community, including using Perfecting Patient CareSM methodology and on-site coaching to improve outpatient care, and strengthen communication and tracking of hospitalized patients. Through this project, an interdisciplinary care team within a federally-funded AIDS clinic reduced the rate of 30-day hospital readmissions through the adoption of Lean quality improvement strategies. PRHI provided training on Lean methodologies to help the clinic create new processes and make its operations more effective and efficient. One year into the project, these efforts have supported a greater than 50% reduction in 30-day hospital readmissions.
Richard Smith, MSW