Abstract
The healthcare of people with HIV is transitioning from specialty care to the primary healthcare (PHC) system. However, many of the performance indicators used to measure the quality of HIV care pre-date this transition. The goal of this work was to examine how existing HIV care performance indicators measure the comprehensive and longitudinal care offered in a PHC setting. A scoping review consisting of peer-reviewed and grey literature searches was performed. Two reviewers evaluated study eligibility and indicators in documents meeting inclusion criteria were extracted into a database. Indicators were matched to a PHC performance measurement framework to determine their applicability for evaluating quality of care in the PHC setting. The literature search identified 221 publications, of which 47 met inclusion criteria. 1184 indicators were extracted and removal of duplicates left 558 unique indicators. A majority of the 558 indicators fell under the ‘secondary prevention’ (12%) and ‘care of chronic conditions’ (33%) domains when indicators were matched to the PHC performance framework. Despite the imbalance, nearly all performance domains in the PHC framework were populated by at least one indicator with significant concentrations in domains such as patient-provider relationship, patient satisfaction, population and community characteristics, and access to care. Existing performance frameworks for the care of people with HIV provide a comprehensive set of indicators that align well with a PHC performance framework. Nonetheless, some important elements of care, such as patient-reported outcomes, are poorly covered by existing indicators. Advancing our understanding of how the experience of care for people with HIV is impacted by changes in health services delivery, specifically more care within the PHC system, will require performance indicators to capture this aspect of HIV care.
Highlights
The health care needs of people living with HIV are evolving as HIV is managed as a chronic condition over increasingly longer lifespans [1]
We explored how well these performance indicators match to a primary healthcare performance framework
Our review was guided by the methodology developed by Arksey and O’Malley [11] to address the research question ‘Do existing performance indicators intended to evaluate the quality of HIV care measure the comprehensive and longitudinal care offered in a primary healthcare (PHC) setting to people living with HIV?’ We adapted the PRISMA methodology to guide our review
Summary
The health care needs of people living with HIV are evolving as HIV is managed as a chronic condition over increasingly longer lifespans [1]. Applicability of HIV Performance Indicators to Primary Care challenging traditional health system structures [2] as they transition from solely within specialist care to increasingly managed within the primary healthcare (PHC) system [3,4]. Continuous measurement of transformative processes and outcomes, as well as relevant feedback to the different stakeholders contributing to change is an essential part of supporting system change [6]. In a complex adaptive system like our evolving health system, different stakeholders contributing to the transformation may need, or value, different information depending on the elements of performance they may influence [8,9]
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