Commission on Cancer Accreditation and Receipt of Guideline-Consistent Care among Non-Hodgkin Lymphoma Patients with an HIV Diagnosis: A Population-based Study in Georgia, 2004 – 2012 Public

Abstract

Background: The Commission on Cancer (CoC) is one of the main accrediting bodies for cancer care. Accreditation promotes the principle that adherence to well-defined standards translates to higher quality healthcare services, and, therefore, improved patient care and outcomes. To date, no studies to our knowledge have investigated the association between accreditation and any quality indicators among cancer patients with human immunodeficiency virus (HIV).

Objectives: The relationship between accreditation and receipt of guideline-consistent care in the US has not been well studied, particularly among patients with both cancer and HIV. This study assesses the association between CoC accreditation and receipt of guideline-consistent care among non-Hodgkin lymphoma patients with HIV (NHL/HIV) in Georgia (GA).

Methods: Data collected by the GA Cancer Registry, GA HIV/AIDS Surveillance Registry, and GA Hospital Discharge Database were linked to identify all patients in GA with NHL and HIV from 2004 – 2012. Bivariate and multivariate logistic regression models were constructed to examine the association between CoC accreditation and receipt guideline-consistent care.

Results: Between January 2004 and December 2012, 328 patients met inclusion criteria for the study. Receipt of guideline-consistent care among NHL patients with HIV who were either diagnosed and/or treated at a CoC-accredited program did not significantly differ from those who were not diagnosed and/or treated at a CoC-accredited program (p = 0.62), even after adjusting for additional predictors (p = 0.60).

Conclusion: CoC accreditation was determined to be not significantly associated with receipt of guideline-consistent care among NHL/HIV patients. This indicates that, in GA, NHL/HIV patients are being handled similarly in terms of receiving guideline-consistent care across facilities, regardless of CoC accreditation status. Additional research should be conducted to establish the relationship between CoC standards and quality indicators to determine if they truly equate to enhanced patient care and outcomes or if they more accurately reflect other differences between CoC and non-CoC facilities, such as structural and patient demographic distinctions. Additionally, research pertaining to patients with both cancer and HIV is limited. As cancer patients with HIV substantially differ from those without HIV, more research is needed to ensure they receive the highest quality care possible.

Table of Contents

CHAPTER I: LITERATURE REVIEW ............................................................................ 1

Non-Hodgkin Lymphoma ....................................................................................... 1

Human Immunodeficiency Virus ............................................................................. 3

Non-Hodgkin Lymphoma and HIV ........................................................................ 5

Accreditation and Receipt of Guideline-Consistent Care ....................................... 6

Additional Factors Associated with Receipt of Guideline-Consistent Care ......... 14

CHAPTER II: MANUSCRIPT......................................................................................... 18

Title Page .............................................................................................................. 19

Abstract ................................................................................................................. 20

Introduction........................................................................................................... 21

Methods ................................................................................................................ 23

Results .................................................................................................................. 29

Discussion ............................................................................................................. 31

References............................................................................................................. 35

Tables .................................................................................................................... 44

Figure .................................................................................................................... 49

CHAPTER III: POSSIBLE FUTURE DIRECTIONS ..................................................... 50

APPENDIX ...................................................................................................................... 53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Oncology Health Sciences, Epidemiology
Mot-clé	Guideline-Consistent Care Non-Hodgkin Lymphoma Accreditation Human Immunodeficiency Virus
Committee Chair / Thesis Advisor	Kevin C. Ward, Emory University
Committee Members	Jeffrey Switchenko, Emory University Joseph Lipscomb, Emory University

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