The Measurement Group
Knowledge Base on HIV/AIDS Care: Cooperative Agreement
Summary of Patient Outcomes Knowledge Items

Both the Summary of Trend Outcomes and Summary of Maximum Outcomes items evaluate degree of success on the same outcome measures (patient-described quality of life enhanced, patient-described symptom severity decreased, patient-described psychological distress decreased, patient-described service barriers decreased, CD4 count increased, Karnofsky rating increased, and viral load decreased) with patients disaggregated by the same service need, vulnerability, and demographic factors. However, the two sets of Knowledge Items differ in their definition of success.

Summary of Trend Outcomes: Knowledge Items in this section define success in terms of whether a patient's scores which increase in an overall (linear) trend toward improvement throughout the entire course of the treatment episode (or, are maintained at the same level as baseline). Hierarchical Linear Modeling (HLM) is used to assess whether patients change systematically over time. Of the two sets of results, these would be considered the most technically sophisticated but the assumption has to be made that the change is systematic and in the same direction throughout the course of treatment, and this definition of successful outcome might not be entirely clinically valid for a progressive disease like HIV/AIDS. This definition of improvement means sustained and systematic change.

• Results derived from Hierarchical Linear Modeling (HLM) Analyses

• Success is coded if a patient systematically improves – in a linear trend – from the baseline level or if the baseline level is maintained (“flat” slope).

• This definition of improvement means sustained and systematic change

• This definition is the most statistically rigorous but may not be the most clinically valid

Summary of Maximum Outcomes: Knowledge Items in this section define success by comparing the patient's "best" possible score from any time during the treatment episode to the baseline score. A successful outcome is one in which the "best" score is at or above the baseline level. Results presented throughout this section permit an assessment of whether patients change at some time during the treatment episode toward better functioning or "health." This definition of improvement means maximum change observed at least once during the treatment episode and could be considered a "typical" clinical definition that a positive outcome had been observed although there could later be relapse.

• Results derived from comparing “best or most-improved” score after the baseline to the “baseline” score.

• Success is coded if the “best” score after the baseline is better than the baseline score or if baseline level is maintained (“best” score = baseline).

• This definition of improvement means positive change from the baseline level is observed at least one time during the treatment episode

• This may be a more clinically valid definition of success but not as statistically rigorous as that from HLM

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Summary of Quality Outcomes: Knowledge Items in this section show levels of client satisfaction with services for groups disaggregated by service need, vulnerability, and demographic factors.

Summary of Retention Outcomes: Knowledge Items in this section summarize the length of time clients are retained in psychosocial services for groups disaggregated by service need, vulnerability, and demographic factors.

Summary of Psychosocial Service Outcomes: Knowledge Items in this section summarize the receipt of nine broadly defined psychosocial services for groups disaggregated by service need, vulnerability, and demographic factors.