Patient Satisfaction, Retention in HIV Care, and Adherence to ART

描述(申请人提供)：邓博士是贝勒医学院感染科的临床讲师。她还即将完成休斯顿退伍军人事务卫生服务研究和发展中心卓越卫生服务研究的博士后奖学金。邓博士将被任命为BCM助理教授，自2013年7月1日起生效。她的首要目标是作为一名独立的临床调查员取得成功，进行有意义的、可操作的研究，以提高艾滋病毒护理的质量。具体地说，她感兴趣的是将患者体验指标作为一种创新的重点，以提高艾滋病毒护理的保留率和对高效抗逆转录病毒疗法(HAART)的坚持。Dang博士将通过与艾滋病毒护理保留方面的全国专家Thomas Giordano博士、经常在客户满意和保留方面的行业顾问Robert Westbrook博士、在干预开发方面具有专业知识的行为科学家Christine Markham博士以及国际公认的与坚持和参与艾滋病毒感染弱势人群护理相关因素的专家Amico博士一起进行指导研究来实现这些目标。辅以有指导的研究，并辅之以有组织的职业发展活动。活动将包括高级研究生水平的课程作业和/或客户/患者评估和体验管理、行为科学和变化理论、行为和社会科学数据分析以及艾滋病毒保留和遵守方面的定向阅读。在这项K23申请中提出的研究试图理解患者满意度的基本行为科学，因为它与HIV护理中的保留和遵守HAART有关。此外，这项研究将确定影响患者评价其艾滋病毒护理的可变因素，特别是那些服务不足的少数群体。总体假设是，满意度较高的患者将更多地保留艾滋病毒护理并坚持HAART。采用混合方法，具体目标是：1)通过对新来临床的患者进行纵向、深入的采访，了解他们如何预期、体验和评估他们的艾滋病毒护理，因为他们的护理在前6个月展开；2)开发和预先测试一项全面评估艾滋病毒患者体验和满意度的量化调查；3)确定患者对基线的总体满意度与在进入护理后12个月内对艾滋病毒护理的保留和对HAART的坚持之间的关系，并确定这种关系的调节因素。本申请中提出的有指导的研究和职业发展活动将扩展Dang博士目前的技能和过去的工作，并使她能够发展成为一名独立调查员，拥有使用患者体验指标的专业知识，以战略性地影响艾滋病毒护理的质量。

DESCRIPTION (provided by applicant): Dr. Dang is a Clinical Instructor of Medicine in the Section of Infectious Diseases at Baylor College of Medicine (BCM). She is also nearing completion of a postdoctoral fellowship in health services research at the Houston Veterans Affairs Health Services Research and Development Center of Excellence. Dr. Dang will be appointed Assistant Professor at BCM effective July 1, 2013. Her overarching goal is to succeed as an independent clinical investigator conducting meaningful, actionable research to improve the quality of HIV care. Specifically, she is interested in using patient experience metrics as an innovative focus for improving retention in HIV care and adherence to highly active antiretroviral therapy (HAART). Dr. Dang will accomplish these goals through mentored research with Dr. Thomas Giordano, a national expert on retention in HIV care, Dr. Robert Westbrook, a frequent industry consultant on customer satisfaction and retention, Dr. Christine Markham, a behavioral scientist with expertise in intervention development, and Dr. Amico, an internationally recognized expert on factors related to adherence and engagement in care for vulnerable populations with HIV. Mentored research with be supplemented with structured career development activities. Activities will include advanced, graduate-level coursework and/or directed readings in customer/patient evaluation and experience management, behavioral science and change theory, analysis of behavioral and social science data, and HIV retention and adherence. The proposed research in this K23 application seeks to understand the basic behavioral science of patient satisfaction as it relates to retention in HIV care and adherence to HAART. Furthermore, this research will identify mutable factors that shape how patients evaluate their HIV care, particularly those in underserved, minority populations. The overall hypothesis is that patients with higher satisfaction will have greater retention in HIV care and adherence to HAART. Applying mixed-methods, the Specific Aims are to: 1) understand how patients anticipate, experience and evaluate their HIV care by conducting longitudinal, in-depth interviews with patients new to clinic as their care unfolds in the first 6 months, 2) develop and pre-test a quantitative survey that comprehensively assesses HIV patient experience and satisfaction, 3) determine the relationship between overall patient satisfaction at baseline and retention in HIV care and adherence to HAART 12-months after entering care, and identify moderators of that relationship. The mentored research and career development activities proposed in this application will expand upon Dr. Dang's current skills and past work and allow her to evolve as an independent investigator with expertise in the use of patient experience metrics to strategically impact the quality of HIV care.