Patient Reported Outcomes in Routine Care: Advancing Data Capture for HIV Cohort Research
Patient Reported Outcomes in Routine Care: Advancing Data Capture for HIV Cohort Research
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DOI：
10.1093/cid/cir727
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发表时间：
2012-01-01
影响因子：
11.8
通讯作者：
Willig, James H.
中科院分区：
文献类型：
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作者：
Kozak, Michael S.;Mugavero, Michael J.;Willig, James H.
导言。患者报告结果的标准化测量(PRO)的计算机化收集为临床护理点的数据捕获提供了一种新的范例。PROS和电子健康记录(EHR)的数据之间缺乏比较。我们比较了EHR和PRO在抑郁症和药物滥用方面的表现，以及它们与坚持抗逆转录病毒治疗(ART)的关系。这项回顾性研究包括2008年4月至2009年7月在一家艾滋病毒诊所完成初步PRO评估的艾滋病毒阳性患者。问卷包括抑郁量表(PHQ-9)和药物滥用量表(ASSITE)。使用独立的Logistic回归分析(EHR与PRO)对自我报告的ART依从性进行建模。这项研究包括782名参与者。EHR与当前药物滥用的预测值分别为13%(n=99)和6%(n=45)(P<；0.0001)，当前抑郁的预测值分别为41%(n=317)和12%(n=97)(P<；0.0001)。在EHR模型中，药物滥用(OR=1.25；95%CI=0.70-2.21)和抑郁(OR=0.93；95%CI=0.62-1.40)均与ART依从性差无关。相反，在PRO模型中，当前滥用药物(OR=2.78；95%CI=1.33-5.81)和当前抑郁(OR=1.93；95%CI=1.12-3.33)与ART依从性差有关。PRO模型的解释性特征与已知的与不良ART依从性相关的因素(药物滥用；抑郁症)相关性最好。作为常规临床护理的一部分，计算机化的专业人员捕获可能被证明是研究和患者护理的补充和潜在的变革性健康信息学技术。
Introduction. Computerized collection of standardized measures of patient reported outcomes (PROs) provides a novel paradigm for data capture at the point of clinical care. Comparisons between data from PROs and Electronic Health Records (EHR) are lacking. We compare EHR and PRO for capture of depression and substance abuse and their relationship to adherence to antiretroviral therapy (ART).Methods. This retrospective study includes HIV-positive patients at an HIV clinic who completed an initial PRO assessment April 2008-July 2009. The questionnaire includes measures of depression (PHQ-9) and substance abuse (ASSIST). Self-reported ART adherence was modeled using separate logistic regression analyses (EHR vs PRO).Results. The study included 782 participants. EHR vs PRO diagnosis of current substance abuse was 13% (n = 99) vs 6% (n = 45) (P < .0001), and current depression was 41% (n = 317) vs 12% (n = 97) (P < .0001). In the EHR model, neither substance abuse (OR = 1.25; 95% CI = 0.70-2.21) nor depression (OR = 0.93; 95% CI = 0.62-1.40) was significantly associated with poor ART adherence. Conversely, in the PRO model, current substance abuse (OR = 2.78; 95% CI = 1.33-5.81) and current depression (OR = 1.93; 95% CI = 1.12-3.33) were associated with poor ART adherence.Discussions. The explanatory characteristics of the PRO model correlated best with factors known to be associated with poor ART adherence (substance abuse; depression). The computerized capture of PROs as a part of routine clinical care may prove to be a complementary and potentially transformative health informatics technology for research and patient care.