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H H S Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Programs

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Severity of Need (SON) Index - Recommendations - Panel Recommendations & Reports

SON Collaboration Panels were the focal point for development of recommendations on what to include or exclude from the draft SON Index. The four panels, comprised of 47 panelists, examined 56+ variables that may impact severity of need. The outcome: 19 variables were forwarded for consideration in the draft SON Index, while 21 variables were identified as important but lacking sufficient data for inclusion. An additional 16 variables were eliminated for various reasons (e.g., further discussion revealed less importance of the variable as a measure of severity of need; unavailability of data).

Collectively, 100+ conference calls and multiple meetings were held. Each panel completed a written report describing their process for eliminating and recommending variables to be included in the SON Index. Panel reports provide a richer insight into the depth of data and complex issues each considered.

Area Characteristics Panel Recommendations

This group examined structural characteristics of an area that make HIV/AIDS care more resource-intensive in one area versus another. They evaluated 20 variables and forwarded 5 for possible inclusion in a SON Index. The Area Characteristics Panel recommended variables on the number of HIV and AIDS cases and adjustment of this count based on measures of access, poverty, and insurance.

The Area Characteristics Panel split into three working groups, based loosely on available data sources, to examine issues in depth:

  • The Burden of Disease Group evaluated ways to measure the number of HIV/AIDS cases in an area and their level of severity using primarily Centers for Disease Control and Prevention (CDC) surveillance data.
  • The Health Infrastructure Group looked at ways to measure access to health care services using the Area Resource File (ARF) and Health Resources and Services Administration (HRSA) internal data.
  • The Poverty and Census Group, evaluated poverty and aggregate measures of the economic health of an area using variables drawn primarily from the U.S. Census and the Bureau of Labor Statistics.

Variables were evaluated based on their importance in determining resource needs for Ryan White services and the current quality, cost, and availability of data used to measure them. They concluded that poor access, high poverty, and low rates of insurance may lead to greater need for Ryan White resources to provide services to the needy and Click here to access the full Area Characteristics Report. to undercounts of HIV/AIDS cases.

Click here to access the full Area Characteristics Report


Patient Coverage and Need Recommendations

This panel looked at estimates of the medical care available to patients and the level of need persons living with HIV disease have for services. They examined 8 variables and recommended inclusion of the following 4 in the SON Index:

  • Case fatality rate among reported living AIDS patients—a proxy indicator for severe cases of unmet need for primary medical care services
  • Medicaid adequacy—the ability of a State Medicaid program to meet the health care needs of patients with HIV/AIDS
  • Percentage of Federal poverty level (FPL) required for eligibility for the Medicaid Medically Needy program—a measure of the presence of such a program and its generosity
  • AIDS Drug Assistance Program (ADAP) ability to meet the medication needs of patients with HIV/AIDS

Click here to access the full Patient Coverage and Need Report


Associated Costs Recommendations

This group reviewed regional differences in medical costs that affect the cost of care, recommending three variables:

  • Geographic wage index—to compensate for regional variation in the cost of labor
  • Geographic non-labor price index—to compensate for regional variation in the cost of facilities
  • Substance abuse (IDU exposure category)—as a proxy for the incrementally higher costs of treating HIV infected individuals who are also substance abusers and, given the high correlation of substance abuse and Hepatitis C, helpful in capturing the cost of co-morbid conditions.

Click here to access the full Associated Costs Report


Patient Characteristics

This panel reviewed characteristics of infected patients that make some populations require more resources than others. They evaluated 20 variables, 5 of which were forwarded for possible inclusion in a SON Index:

  • HIV/AIDS disease progression
  • Race/ethnicity
  • IDU exposure category
  • Age
  • Sex

These variables were among those selected as a result of deliberations by three subgroups: clinical, co-morbidities, and demographics, each of which outlined the rationale for inclusion or exclusion based upon such considerations as potential sources of data and data quality. Deliberations were brought back to the full group for final panel recommendations.

Click here to access the full Patient Characteristics Report