Evaluating Patient Retention in HIV Care

评估艾滋病毒护理中的患者保留率

基本信息

批准号：
8467277
负责人：
Baligh Ramzi Yehia
金额：
$ 18.05万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-19 至 2017-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8467277
关键词：
AIDS/HIV problem Address Adherence Affect Ambulatory Care Appointment Appointments and Schedules Behavior Behavioral Model CD4 Lymphocyte Count CD4 Positive T Lymphocytes Caring Cell Count Cells Characteristics Chronic Clinic Clinical Cohort Studies Communicable Diseases Comorbidity Computerized Medical Record Consensus Coping Skills Data Data Collection Development Development Plans Diagnosis Diagnostic Services Education and Outreach Enrollment Environment Environmental Risk Factor Evaluation Foundations Future Goals HIV HIV-1 Health Care Costs Health Services Health Services Accessibility Health behavior Health behavior outcomes Health system Hour Individual Intervention Interview Knowledge Lead Life Measurement Measures Medical Mental Health Mental disorders Mentors Methodology Methods Modeling Morbidity - disease rate Outcome Outcome Measure Outcome Study Outpatients Patient Education Patients Pattern Patterns of Care Pennsylvania Performance Persons Policies Process Provider Psychosocial Factor Qualitative Research Quality of Care RNA Research Research Personnel Risk Science Self Efficacy Services Site Social support Stigmata Structure Substance abuse problem Surveys Technology Testing Therapeutic Training Transportation Trust Universities Viral Load result Virus Diseases Visit Work antiretroviral therapy care seeking career clinical care clinical practice cohort compliance behavior coping evidence base experience health care delivery health care quality health information technology improved instrument longitudinal analysis meetings mortality outreach program patient oriented predictive modeling prospective social stigma supported housing therapy design time interval tool transmission process

项目摘要

DESCRIPTION (provided by applicant): Despite the availability of effective antiretroviral therapy, more than half of people living with HIV are not engaged in regular outpatient HIV care. Consequently there is increased need to improve engagement and retention in care. Dr. Baligh Yehia is a postdoctoral infectious diseases fellow at the University of Pennsylvania. His long-term career goal is to conduct research that informs clinical practice and national policy for persons living with chronic viral diseases. The overall purpose of this K23 proposal is to train Dr Yehia for a career as an independent investigator. His plans for development into an independent investigator include gaining competency in analysis of longitudinal cohort data, implementation and analysis of qualitative research, understanding patient behaviors and adherence practices, and evaluation of health care delivery models. He will benefit from an outstanding mentoring team lead by Drs. Joshua Metlay, Kelly Gebo, and Karen Glanz, who have extensive experience in conducting health services, quality of care, and health behavior research. These experiences will occur within the rich research environment offered by the University of Pennsylvania. Improving retention in care is critical to receiving antiretroviral therapy, lowering HIV transmission, and reducing health care costs. This proposal intends to advance the science of patient adherence to outpatient care and seeks to identify health system and patient factors influencing retention in care, with the ultimate goal of improving health care quality for persons living with HIV. To accomplish this goal, three studies will be pursued to: 1) determine the relationship between patterns of retention in outpatient HIV care and clinical outcomes~ 2) develop and administer two surveys that will assess environmental and patient factors that may impact patterns of retention in outpatient HIV care~ and 3) identify environmental and patient factors associated with patterns of retention in outpatient HIV care. These studies test relationships between patient factors, environment factors, health behaviors, and outcomes identified in Anderson's Behavioral Model. A mixed methods approach will be used, combining quantitative (retrospective and prospective clinical cohorts) and qualitative (patient interviews and survey development and implementation) methodologies. At the competition of this project, Dr. Yehia will be trained as an independent investigator working to improve HIV health care quality, and will embark on future studies developing a predictive model to identify patients at risk of disengaging from care and testing interventions aimed at improving linkage to and retention in outpatient HIV care. PUBLIC HEALTH RELEVANCE: Engaging and retaining HIV-infected individuals in care is essential for prolonging life, decreasing HIV transmission, and avoiding HIV-associated complications. This research will evaluate outcomes of varying patterns of retention in outpatient HIV care and identify patient and health system barriers to retaining patients in continuous medical care. With this knowledge, predictive models to identify patients at risk of disengaging from care and interventions focused on addressing barriers to care can be implemented.

描述（由申请人提供）：尽管有效的抗逆转录病毒疗法可用，但超过一半的艾滋病毒患者并未从事常规的门诊HIV护理。因此，增加了提高参与和保留护理的需求。 Baligh Yehia博士是宾夕法尼亚大学的博士后传染病研究员。他的长期职业目标是进行研究，以为患有慢性病毒疾病患者的临床实践和国家政策提供信息。这项K23提案的总体目的是培训Yehia博士的职业生涯。他向独立研究者开发的计划包括获得分析纵向队列数据的能力，定性研究的实施和分析，了解患者行为和依从性实践以及评估医疗保健提供模型。他将从DRS的杰出指导团队领导中受益。 Joshua Metlay，Kelly Gebo和Karen Glanz在开展卫生服务，护理质量和健康行为研究方面拥有丰富的经验。这些经验将发生在宾夕法尼亚大学提供的丰富研究环境中。改善护理保留率对于接受抗逆转录病毒疗法，降低HIV传播并降低医疗保健费用至关重要。该提案旨在提高患者依从性科学对门诊护理的科学，并旨在确定影响保留护理的卫生系统和患者因素，最终目的是改善HIV患者的卫生保健质量。为了实现这一目标，将进行三项研究：1）确定门诊HIV护理和临床结果中保留模式之间的关系。这些研究测试了安德森行为模型中确定的患者因素，环境因素，健康行为和结果之间的关系。将使用一种混合方法方法，结合定量（回顾性和前瞻性临床人群）和定性（患者访谈以及调查开发和实施）方法。在该项目的竞争中，Yehia博士将被培训为一名独立研究者，旨在提高HIV卫生保健质量，并将开始开发一种预测模型，以识别有可能脱离护理和测试干预措施的患者，旨在改善与培训和保留疗法的HIV HIV护理。公共卫生相关性：参与和保留受艾滋病毒感染的人护理，对于延长寿命，减少艾滋病毒传播以及避免艾滋病毒相关并发症至关重要。这项研究将评估门诊艾滋病毒护理中保留的不同模式的结果，并确定患者和卫生系统障碍在连续医疗中保留患者。有了这些知识，可以实施有预测模型，以确定有脱离护理的风险的患者，并且可以实施重点是解决护理障碍的干预措施。