Reported Care Quality in Federal Ryan White HIV/AIDS Program Supported Networks of HIV/AIDS Care

The US government has, since 1991, funded medical and support services for people living with HIV/AIDS through the Ryan White HIV/AIDS Program. The program supports care networks for patients in 51 Eligible Metropolitan Areas (EMAs). The 2000 reauthorization of Ryan White mandated quality management programs for all sites receiving the funding.

To facilitate quality management and improvement activities in EMAs, the authors developed a set of surveys to measure characteristics of care networks and the quality, accessibility, and coordination of services from the perspective of case management and medical providers, administrators, and consumers. These surveys measured quality management and support activities of the entire network, in addition to reported quality of services at individual sites. The surveys were administered in 42 EMAs in the continental United States from a total of 43 that had not participated in earlier pilot testing.

The results showed the care networks were rated highly on access, quality, and coordination between case management and primary care providers. Frequent differences in ratings of quality and barriers were noted by type of respondent (consumer representatives, grantees, and providers). Also noted were "substantial variations" across EMAs in network characteristics, perceived effectiveness, performance measurement, and quality improvement activities.

"The results indicate that the Ryan White Program has been successful in some areas of developing networks of care, but additional support is needed to strengthen the comprehensiveness and coordination of care," the authors concluded. "Additional work is also needed to better define and measure the essential characteristics of coordinated and integrated networks of care and assess whether those characteristics are related to access and quality of care and services."

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