Kelly K Richardson1, Barbara Bokhour2, D Keith McInnes2, Vera Yakovchenko2, Leonore Okwara3, Amanda M Midboe3, Avy Skolnik4, Mary Vaughan-Sarrazin5, Steven M Asch6, Allen L Gifford2, Michael E Ohl5. 1. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA. Electronic address: Kelly.richardson@va.gov. 2. Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA. 3. Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA. 4. Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA. 5. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA. 6. Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Division of General Medical Science, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Dr, Palo Alto, CA 94304, USA.
Abstract
BACKGROUND: Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States. METHOD: The cohort included 23,974 Veterans in care for HIV in 2013 (53.4% black; 46.6% white). Measures extracted from electronic health record and administrative data were receipt of combination antiretroviral therapy (cART), HIV viral control (serum RNA < 200 copies/ml among those on cART), hypertension control (blood pressure < 140/90 mm Hg among those with hypertension), diabetes control (hemoglobin A1C < 9% among those with diabetes), lipid monitoring, guideline-concordant antidepressant prescribing, and initiation and engagement in substance use disorder (SUD) treatment. Black persons were less likely than their white counterparts to receive cART (90.2% vs. 93.2%, p<.001), and experience viral control (84.6% vs. 91.3%, p<.001), hypertension control (61.9% vs. 68.3%, p<.001), diabetes control (85.5% vs. 89.5%, p<.001), and lipid monitoring (81.5% vs. 85.2%, p<.001). Initiation and engagement in SUD treatment were similar among blacks and whites. Differences remained after adjusting for age, comorbidity, retention in HIV care, and a measure of neighborhood social disadvantage created from census data. SIGNIFICANCE: Implementation of interventions to reduce racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities. Published by Elsevier Inc.
BACKGROUND: Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States. METHOD: The cohort included 23,974 Veterans in care for HIV in 2013 (53.4% black; 46.6% white). Measures extracted from electronic health record and administrative data were receipt of combination antiretroviral therapy (cART), HIV viral control (serum RNA < 200 copies/ml among those on cART), hypertension control (blood pressure < 140/90 mm Hg among those with hypertension), diabetes control (hemoglobin A1C < 9% among those with diabetes), lipid monitoring, guideline-concordant antidepressant prescribing, and initiation and engagement in substance use disorder (SUD) treatment. Black persons were less likely than their white counterparts to receive cART (90.2% vs. 93.2%, p<.001), and experience viral control (84.6% vs. 91.3%, p<.001), hypertension control (61.9% vs. 68.3%, p<.001), diabetes control (85.5% vs. 89.5%, p<.001), and lipid monitoring (81.5% vs. 85.2%, p<.001). Initiation and engagement in SUD treatment were similar among blacks and whites. Differences remained after adjusting for age, comorbidity, retention in HIV care, and a measure of neighborhood social disadvantage created from census data. SIGNIFICANCE: Implementation of interventions to reduce racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities. Published by Elsevier Inc.
Entities:
Keywords:
Comorbidity; HIV; Racial disparities; Vet
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