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Use of antiretroviral therapy in older people with HIV during care transition

在护理过渡期间对感染艾滋病毒的老年人使用抗逆转录病毒疗法

基本信息

批准号：
10684940
负责人：
Tingting Zhang
金额：
$ 7.98万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10684940
关键词：
Acquired Immunodeficiency Syndrome Acute Address Adherence Admission activity Adult Age Years Aging Back Biometry Caring Cessation of life Characteristics Chronic Clinical Data Clinical Management Complex Coronary heart disease County Data Data Files Diabetes Mellitus Diagnosis Discipline of Nursing Disincentive Drops Drug Prescriptions Elderly Elements Epidemiologic Methods Evidence based intervention Fee-for-Service Plans Future Goals Grant HIV HIV therapy Health Services Research Health care facility Home Home Nursing Care Hospitalization Hospitals Hyperlipidemia Hypertension Individual Institution Intervention Knowledge Length of Stay Link Long-Term Care Longevity Medical Medicare Medicare claim Medication Errors Mental Health Methods Modeling Neighborhoods Nursing Homes Outcome Outpatients Patient Care Patients Pattern Persons Pharmaceutical Preparations Pharmacoepidemiology Polypharmacy Poverty Prevalence Process Provider Proxy Quality of Care Quality of life Recommendation Records Regimen Reporting Research Retrospective cohort study Risk Role Substance abuse problem Time United States Viral Viral Load result Work acute care aging population antiretroviral therapy cohort comorbidity demographics experience health management hospitalization rates improved mortality risk nursing home length of stay therapy adherence transmission process

项目摘要

Project Summary Background. The number of older people living with HIV (PLWH) in the U.S. is growing rapidly. Half of PLWH in 2016 were over 50 years of age, with an estimate of 70% by 2030. PLWH have high numbers of comorbidities, polypharmacy and high hospitalization rates. The transitions between care settings (e.g., home, hospital, post-acute care, and long-term care) that necessarily occur for PLWH who are aging – and the quality of care problems that these transitions create – are the focus of this proposal. Previous studies in the general aging population show that problems with medications are common after a hospitalization; approximately one fourth did not fill new prescriptions,14% experienced medication discrepancies and almost half were not adherent to medications following hospitalizations. There is limited data about medication-related quality problems following hospitalization for PLWH. In a recent study, only 64% of the study patients in the nursing homes (NHs) used ART. Our preliminary work with Medicare recipients has shown that about two thirds of a national cohort of NH residents with Part D (Medicare drug coverage) and HIV did not receive an ART during an average of 1 years of observation in NHs. The purposes of this proposed research are to (1) determine patterns of ART use in PLWH who made the care transition from outpatient status to NH care; and (2) identify patient level characteristics and nursing facility characteristics that are associated with the lack of ART use during NH stays following hospital discharge transitions. Methods. We propose to conduct a retrospective cohort study including all Medicare fee-for-service NH residents (2014-2018) nationally. First, we will identify PLWH who had an acute hospitalization that led to a NH admission. We will follow them to examine ART use during post-hospital discharge NH stays, and follow them backward in time to the prehospital period to determine whether they were on ART as outpatients. We will conduct multivariable models to determine correlates of non-ART use following the care transition. Covariates will include individual level characteristics, such as demographics, polypharmacy, comorbidity status, hospitalization length of stay and diagnosis; and nursing facility level characteristics such as HIV concentration, the availability of an AIDS unit and county level HIV prevalence as a proxy of provider HIV experience. Expected findings and future plans. We expect to observe that a reduction in ART use following the hospital discharge transition to NHs. ART use is a critical element of high-quality HIV care, and we are concerned that dropping of an ART regimen at NHs is a marker or indicator of broader quality of care problems. Our study will identify a clear focus for quality improvement interventions to ensure that PLWH in NHs (absent contraindications) are using ART. Our methods will also be used to conduct similar studies to ensure that other medications for chronic conditions are appropriately continued through complex care transitions.

项目总结