Quality Outcomes for Patients with Drug Abuse and HIV

描述（由申请人提供）：本申请提出了一个培训计划，旨在培养P. Todd Korthuis， MD， MPH，成为一名独立的临床科学家，研究药物滥用和艾滋病毒。Korthuis博士是一名普通内科医生，专门治疗艾滋病毒感染者。指导的职业发展计划包括三个层次的方法：正式的课程，以增强他以前获得的技能，广泛的体验式学习计划，以及指导的临床研究经验。这个项目的主要目标是让Korthuis博士在各个方面都能独立地成为一名临床研究者。他的教育目标是提高他对药物滥用理论和治疗的理解，获得定性和定量研究设计和分析方法的先进专业知识，同时保持他在与药物滥用患者相关的艾滋病毒治疗和预防问题方面的专业知识。他将在他的主要导师、药物滥用研究和政策中心主任Dennis McCarty博士、OHSU医学和卫生服务研究员David Hickam博士、经验丰富的定性方法研究员Carla Green博士和加州大学洛杉矶分校医学副教授、退伍军人管理局艾滋病毒质量提高研究计划主任Steven Asch博士的指导下进行临床研究。国家艾滋病毒研究网络首席研究员Richard Moore博士和HRSA国家意义综合丁丙诺啡和艾滋病毒护理评估和支持中心特别项目首席研究员Ruth Finkelstein博士将确保数据访问和对拟议目标的持续支持。拟议的研究侧重于确定同时发生药物滥用和艾滋病毒感染的患者的质量结果。虽然药物滥用和艾滋病毒感染都有有效的治疗方法，但它们对提高护理结果质量（如抑制艾滋病毒）的影响尚不清楚。我的理论是，同时发生药物滥用和艾滋病毒感染的患者通过结合医疗保健结构和患者特征来实现高质量的结果。我的中心假设是，在有药物滥用史的人中，更好的HIV护理质量总结得分与获得药物滥用治疗、高水平的指示性护理和集中综合药物滥用治疗护理有关。为了验证这一假设，我打算进行三项研究：(1)确定获得药物滥用治疗对艾滋病毒护理质量的影响，(2)确定指示性护理对艾滋病毒结局的影响，以及(3)确定药物滥用和艾滋病毒综合护理对不同程度药物使用人群的艾滋病毒护理质量的影响。

DESCRIPTION (provided by applicant): This application proposes a training program to develop P. Todd Korthuis, MD, MPH into an independent clinician-scientist in investigations of drug abuse and HIV. Dr. Korthuis is a General Internist who specializes in caring for HIV-infected patients. The mentored career development plan consists of a three-tiered approach: formal coursework to augment his previously acquired skills, a broad-based experiential learning program, and a mentored clinical research experience. The primary goal of this program will be for Dr. Korthuis to achieve independence as a clinical investigator in all respects. His educational goals for this award are to advance his understanding of drug abuse theory and treatment and obtain advanced expertise in qualitative and quantitative research design and analysis methods while maintaining his expertise in HIV treatment and prevention issues pertinent to patients with drug abuse. He will conduct mentored clinical research under the direction of his primary mentor, Dr. Dennis McCarty, Director of the Center for Substance Abuse Research and Policy, and co-mentors Dr. David Hickam, Professor of Medicine and health services researcher at OHSU, Dr. Carla Green, an experienced qualitative methods researcher, and Dr. Steven Asch, Associate Professor of Medicine at UCLA and director of the Veteran's Administration HIV Quality Enhancement Research Initiative. Dr. Richard Moore, principal investigator of the national HIV Research Network, and Dr. Ruth Finkelstein, principal investigator of the HRSA Special Projects of National Significance Integrated Buprenorphine and HIV Care Evaluation and Support Center will assure data access and continued support for the proposed aims. The proposed research focuses on identifying quality outcomes for patients with co-occurring drug abuse and HIV infection. Though effective treatments exist for both drug abuse and HIV infection, their impact on improving quality of care outcomes like HIV viral suppression remains unclear. I theorize that patients with co-occurring drug abuse and HIV infection achieve quality outcomes through a combination of healthcare structural and patient characteristics. My central hypothesis is that among persons with a history of drug abuse, better HIV quality of care summary scores are associated with access to drug abuse treatment, high levels of indicated care, and centrally integrated drug abuse treatment care. To test this hypothesis, I aim to conduct three studies to (1) determine the effect of access to drug abuse treatment on HIV quality of care, (2) determine the effect of indicated care on HIV outcomes, and (3) determine the effect of integrated drug abuse and HIV care on HIV quality of care among persons with varying degrees of drug use over time.