Developing an HIV-Specific Prevention Index Using the Electronic Medical Record

申请者描述(申请人提供)：本申请是响应PA-09-070，AHRQ卫生服务研究项目(R01)而提交的。新的治疗方法正在延长艾滋病毒患者的预期寿命，反过来也提高了他们所接受的医疗保健质量的重要性。这项研究将评估西北部和加利福尼亚州4000名感染艾滋病毒的Kaiser Permanente(KP)患者样本中艾滋病毒治疗提供者成功的临床护理(反映在对推荐的预防和筛查指南的遵守)与护理质量和结果之间的关联程度。具体项目目标包括：1.制定新的综合质量护理措施，用于管理感染艾滋病毒的患者。1A.使用KP电子医疗记录和数据系统，计算接受各种建议的一般预防和针对艾滋病毒的服务所涵盖的患者时间相对于患者符合覆盖条件的时间--“预防指数-艾滋病毒”(PIH)，量化对建议的预防性保健服务的既定标准的遵守情况。1B.计算艾滋病毒患者在与艾滋病毒管理相关的各种临床措施的既定标准内的程度--“疾病管理指数-艾滋病毒”(DMIH)。我们将计算首次HIV诊断后12个月内的妊高征值和DMIH值。除了具体服务的PIH和DMIH之外，我们的目标是为一套被认为对艾滋病毒患者的护理非常重要的代表性服务和措施编制一份PIH和DMIH的摘要。2.检查目标1中的护理质量措施与临床结果的关系。2A。根据艾滋病毒护理的长期趋势，评估历年估计的具体服务和汇总PIHS和DMIHs的时间趋势，以评估艾滋病毒患者的护理质量。2B。评估DX后12个月PIH和DMIHs的较高水平，是否预测使用最新的高效抗逆转录病毒治疗方案，遵守和/或改变这种方案，以及选定的艾滋病毒相关结局的变化。3.研究实践差异与已开发的护理质量措施之间的关系。3A.探索不同的提供者特征如何导致实践差异，从而影响PIH和DMIH。由经验丰富的卫生服务研究人员和艾滋病毒临床专家组成的研究小组将使用KP的电子医疗记录和数据系统来探索和描述一般临床护理与结果的关联。我们期望我们的结果能更好地理解初级保健实践特征对艾滋病毒患者的护理质量和结果的影响。 与公共卫生相关：正在制定反映艾滋病毒护理范围的高质量绩效指标，包括艾滋病毒疾病的检测和诊断、获得护理和后续服务的机会、适当使用抗逆转录病毒疗法(ART)和机会性感染预防，以及患者按ART规定的结果衡量标准。这项研究的结果将显示一般卫生预防和艾滋病毒相关卫生预防的不足之处，以及需要更系统的干预措施来改善艾滋病毒感染患者的健康维护。

DESCRIPTION (provided by applicant): This application is submitted in response to PA-09-070, AHRQ Health Services Research Projects (R01). New therapies are increasing the life expectancy for patients with HIV and, in turn, the importance of the quality of the health care they receive. This study will assess the degree of association between successful clinical care by HIV treatment providers (reflected in adherence to recommended prevention and screening guidelines) and quality of care and outcomes for a sample of 4,000 HIV-infected Kaiser Permanente (KP) patients in the Northwest and California. Specific project aims include: 1. Develop new composite quality of care measures for use in the management of patients infected with HIV. 1a. Using KP electronic medical records and data systems, calculate the proportion of patient time covered by receipt of various recommended general preventive and HIV-specific services, relative to the time during which patients were coverage-eligible-the "Prevention Index-HIV" (PIH), quantifying adherence to established standards for recommended preventive health services. 1b. Calculate the degree to which patients with HIV are within established standards for various clinical measures relevant to HIV management-the "Disease Management Index-HIV" (DMIH). We will calculate a PIH and DMIH for multiple 12-month periods following initial HIV diagnosis. In addition to service-specific PIHs and DMIHs, our objective is to produce a summary PIH and DMIH for a representative set of services and measures considered important to the care of patients with HIV. 2. Examine the association of the quality of care measures from Aim 1 with clinical outcomes. 2a. Assess the temporal trend of the estimated service-specific and summary PIHs and DMIHs across years to evaluate the quality of care for patients with HIV, adjusting for secular trends in HIV care. 2b. Assess whether higher levels of the 12-month post-dx PIHs and DMIHs, predict use of the latest highly active anti-retroviral therapy regimens, adherence to and/or changes in such regimens, and changes in selected HIV-related outcomes. 3. Study the association of practice variation with the developed quality of care measures. 3a. Explore how different provider characteristics induce practice variation, and thus affect the PIH and DMIH. The study team of experienced health services researchers and HIV clinical experts will use KP's electronic medical record and data systems to explore and describe the association of general clinical care with outcomes. We expect our results to improve understanding of the influence of primary care practice characteristics on the quality of care and outcomes for patients with HIV. PUBLIC HEALTH RELEVANCE: Quality performance measures are being developed that reflect the spectrum of HIV care, including testing for and diagnosis of HIV disease, access to care and follow-up, appropriate use of antiretroviral therapy (ART) and opportunistic infection prevention, and outcome measures for patients prescribed ART. The results of this study will show where both general health prevention and HIV-related health prevention are deficient, and where more systematic interventions to improve health maintenance among HIV-infected patients are needed.