Leveraging data to identify opportunities to address insecure care connections and poor health outcomes among people living with HIV

利用数据寻找机会来解决艾滋病毒感染者中不安全的护理联系和不良的健康结果

• 批准号: 10391444
• 负责人: Sarah Elizabeth Wiehe
• 金额: $ 75.93万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-13 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10391444
• 关键词: AIDS/HIV problem; Address; Caring; Characteristics; Clinical; Clinical Data; Communities; Complement; Complex; Continuity of Patient Care; County; Criminal Justice; Data; Data Security; Data Set; Data Sources; Database Management Systems; Databases; Death Certificates; Diagnosis; Enrollment; Epidemiology; Food; Foundations; Government Programs; Guidelines; HIV; Health; Healthcare; Household; Housing; Indiana; Individual; Infrastructure; Insurance Coverage; Interruption; Intervention; Justice; Laboratories; Learning; Life Cycle Stages; Link; Longitudinal cohort; Measures; Medicaid; Mental Health; Methods; Modeling; NIH Program Announcements; Neighborhoods; Outcome; Pattern; Performance; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Poverty Areas; Pregnancy; Provider; Public Health; Public Health Practice; Public Policy; Records; Reporting; Research; Research Personnel; Retrospective cohort; Sexually Transmitted Diseases; Social Work; Social support; Source; State Government; System; Test Result; Time; Translations; Viral; Viral Load result; automated analysis; base; care outcomes; care systems; clinical care; clinical encounter; contextual factors; data access; data hub; data repository; demographics; health data; high risk; improved; longitudinal database; longitudinal dataset; metropolitan; migration; outreach services; predictive modeling; response; service utilization; social health determinants; socioeconomics; surveillance data; welfare

SUMMARY/ABSTRACT To determine correlates of poor vs. good HIV outcomes among people living with HIV (PLWH), researchers have focused on clinical data. Hence, there is limited understanding of non‐clinical correlates and migration patterns of PLWH who have insecure (or fragmented) connections with the care system. This proposal will leverage our unique access to clinical and non‐clinical data to measure HIV care outcomes and identify intervention opportunities to address insecure connection to care and poor outcomes inPLWH. Our team has individually linked data from the Enhanced HIV/AIDS Reporting System (eHARS), the national HIV surveillance database, with other public health, clinical, and criminal justice data. We use these data to conduct population‐level epidemiology of over 10,000 PLWH in Marion County (Indianapolis), Indiana between 2000 and the present. We propose to link these data with social determinants of health data within the Indiana Management Performance Hub (MPH), a collaborative state government data‐sharing hub. MPH data will complement our rich data repository by adding socioeconomic, household, and neighborhood characteristics, social service utilization (welfare, food stamps, etc.), and mental health data for PLWH. Given the complex intersection of social determinants of health and migration within and between counties (e.g., because of housing insecurity or discontinuity of insurance coverage), we will also investigate how migration relates to insecure care connections and poor outcomes. Our access to these data sources will permit us to focus on both social determinants of health and migration, and will provide us with the unprecedented ability (1) to investigate how these factors relate to HIV outcomes over time, and (2) to identify intervention opportunities (times and places) to improve connection to care and clinical outcomes in PLWH. The objective of our research is to investigate correlates, and opportunities for improvement, of poor HIV health outcomes in Marion County (Indianapolis), Indiana. The hypothesis is that identification of correlates of poor retention in care and of poor viral suppression will identify opportunities to improve health outcomes for PLWH who are insecurely connected to care. We aim to (1) Analyze patterns in social services utilization among PLWH to (a) understand correlates of poor HIV outcomes and (b) identify non‐clinical opportunities for intervention; (2) Determine if within‐county and between‐county migration patterns after diagnosis predict poor HIV care outcomes; (2a) Identify demographic, socioeconomic, life‐course, and contextual factors associated with worse HIV outcomes among those who migrate; and (3) Develop a model to extend the utility of eHARS data for longitudinal research and public health practice, with guidance from a stakeholder advisory panel. Results from this project will inform a subsequent R01 application assessing whether supplemental wrap‐around and outreach services for those identified at higher risk due to non‐clinical service utilization and migration patterns improve care and outcomes of PLWH.

摘要/摘要 为了确定艾滋病病毒携带者(PLWH)的不良和良好结果的相关性，研究人员 都专注于临床数据。因此，对非临床相关性和迁移的了解有限。 与护理系统有不安全(或支离破碎)联系的PLWH的模式。这项提议将 利用我们对临床和非临床数据的独特访问来衡量艾滋病毒护理结果并确定 干预机会，以解决与护理的不安全连接和PLWH的不良结局。 我们的团队单独链接了来自增强的艾滋病毒/艾滋病报告系统(EHARS)的数据，该系统是国家 艾滋病毒监测数据库，以及其他公共卫生、临床和刑事司法数据。我们使用这些数据来 在印第安纳州马里恩县(印第安纳波利斯)对10,000多名PLWH进行人口水平的流行病学调查 从2000年到现在。我们建议将这些数据与健康数据的社会决定因素联系起来 印第安纳州管理绩效中心(MPH)，一个协作性的州政府数据共享中心。每小时 数据将通过添加社会经济、家庭和社区来补充我们丰富的数据存储库 公共卫生部门的特征、社会服务利用情况(福利、食品券等)和精神健康数据。vt.给出 健康和迁徙的社会决定因素在县内和县之间的复杂交集(例如， 由于住房不安全或保险覆盖范围中断)，我们还将调查移徙如何 与不安全的护理连接和不良结局有关。我们对这些数据源的访问将使我们能够专注于 健康和移徙的社会决定因素，并将为我们提供前所未有的能力 (1)调查这些因素如何随时间推移与艾滋病毒结果相关，以及(2)确定干预措施 机会(时间和地点)改善与PLWH的护理和临床结果的联系。 我们研究的目的是调查贫穷的艾滋病毒的相关性和改善的机会 印第安纳州马里恩县(印第安纳波利斯)的健康结果。假设是相关因素的识别 护理保持率低和病毒抑制差的情况将确定改善健康结果的机会 对于那些不安全地连接到护理的PLWH。我们的目标是(1)分析社会服务利用的模式 在PLWH中，以(A)了解不良艾滋病毒结局的相关因素和(B)确定非临床 干预的机会；(2)确定县内和县间的移徙模式 在诊断后预测不良的艾滋病毒护理结果；(2a)确定人口统计、社会经济、生命过程和 背景因素与移居者中较差的艾滋病毒结局相关；以及(3)开发一个模型 扩大eHARS数据在纵向研究和公共卫生实践中的效用，并提供指导 来自一个利益相关者咨询小组。该项目的结果将通知后续的R01申请 评估是否为那些因以下原因而被确定为风险较高的人提供补充周转和外展服务 非临床服务利用和迁移模式改善了PLWH的护理和结果。