VISION: a regional performance improvement initiative for HIV health care providers.

INTRODUCTION: VISION (HIV Integrated Learning ModuleS: Achieving Performance Improvement through CollaboratiON) was a regional performance improvement (PI) continuing medical education (CME) initiative designed to increase guideline-conforming practice of clinicians who manage patients with HIV infection. METHODS: The 3-part activity consisted of (1) clinical practice assessment and development of an action plan for practice change, (2) completion of relevant education, and (3) reassessment. RESULTS: The activity did not change practitioners' performance in clinical status monitoring and in patient treatment, in large part because guidelines were being appropriately implemented at baseline as well as after the educational intervention. There was a trend toward improvement, however, in practitioner performance in the area of patient medication adherence (increased from 66% to 74%). DISCUSSION: Results observed in the VISION initiative were consistent with HIVQUAL metrics. Ongoing education in HIV is important, and VISION demonstrated performance improvement in medication adherence, a critical aspect of health care.

Changing HIV clinical knowledge and skill in context: the impact of longitudinal training in the Southeast United States.

In the Southeast United States, HIV care is provided in a context of disproportionate HIV prevalence and barriers to care, including rural locales, higher proportions of African American and uninsured patients, and inadequate health care workforce and infrastructure. The authors describe a regional on-site longitudinal training program developed to target multidisciplinary teams providing HIV primary care at clinical sites in the region. The effect of this training program was evaluated using pre- and 3-month post-program knowledge and skills tests, a post-training evaluation questionnaire, and a post-program focus group. The authors found desired effects, with increases in knowledge and skills and improved capacity of providers to meet patient care needs across all clinical sites despite variations in terms of HIV-infected patient loads. However, the lack of enabling factors present in clinic environments may attenuate the application of new knowledge and skills, underscoring the relevance of teamwork training in HIV care settings.