Passion to Improve

HIV/AIDS Clinical Care Program Uses Decades of Clinical Data to Continually Improve Quality

As a new physician in the early 1980s, Steven Johnson, MD​, remembers when there wasn’t an effective way to treat the AIDS virus. In fact, when the University of Colorado Hospital treated the first case of AIDS in Colorado in 1982, HIV infection was largely a death sentence. 

Today, more than 2,200 patients in our region are successfully treated through the hospital’s HIV/AIDS Clinical Care Program and its collaborative clinics around the state. Although the virus isn’t dramatically different than it was in the beginning, one thing related to HIV/AIDS has changed significantly: Clinical outcomes.

Dr. Johnson has been tracking data and outcomes since he assumed the Medical Director role of the HIV AIDS Program in 1994. When he first started, the annual mortality rate was more than 15 percent. Today, the annual mortality rate is 1 percent. And, of the 89 deaths that have occurred over the last five years, only 18 percent can be directly attributed to AIDS-defining conditions. 

But considering the HIV/AIDS patient population is disproportionately impacted by mental health issues and poverty, treatment adherence and retention in care are big priorities for Dr. Johnson and his team. His team also focuses on important co-morbidities such as tobacco use, other drug use, cardiovascular disease and HIV-Hepatitis C co-infection.

“It’s important to remember that HIV is still a lethal virus if you’re not adherent with treatment,” says Dr. Johnson. This is why the program focuses so heavily on its data to quickly identify and remedy barriers to treatment.  

A strong focus on primary care as well as specialized programs for women’s care and HIV-hepatitis co-infection contribute to the program’s successes. The multidisciplinary approach provides patients with access to HIV-focused primary care, Mental Health Care, and other types of specialist care, such as Dermatology and Endocrinology. The program has a highly dedicated and experienced group of nurses, social workers, pharmacists, and other clinic staff to help provide comprehensive care. Patients also have access to cutting-edge treatments through the affiliated clinical research program.  

“Our mission isn’t just about HIV care. We provide care for the total patient,” says Dr. Johnson. 

The program’s clinical outcomes data document that 99 percent of patients are on HIV treatments, 85 percent of patients have full suppression of their virus, hospitalization rates are low, the rate of opportunistic infections is low and patient satisfaction is very high. In addition, the program operates cost-effectively, primarily because of low hospitalization rates and the availability of federal Ryan White CARE Act​ funding. 

More recently, Dr. Johnson mined the program’s data and uncovered an important aspect of the care the program provides. From July 2013 to June 2014, clinic visits accounted for only 20 percent of the nearly 50,000 electronic health record encounters recorded. Other forms of care included patient emails, patient phone calls, review of lab and test results, and other aspects of care coordination. 

“This reflects how much we do for our patients that is not necessarily recognized in a fee-for-service environment. Our program has functioned as a patient-centered medical home well before that term was even popularized,” says Dr. Johnson. 

As a QI veteran, Dr. Johnson understands the challenges clinical care departments face when embarking on quality improvement (QI) initiatives. He’s learned that QI isn’t just about improving clinical outcomes; it’s about maintaining these improvements over time. 

“QI isn’t a discrete project that will end,” he says. “It’s an ongoing investment in time. It’s an integral part of our process of care. You have to always be looking for ways to innovate and maintain your focus.”