Risk factors for chronic obstructive pulmonary disease exacerbations, quality of care, and outcomes in people with HIV

项目总结和摘要 慢性阻塞性肺疾病（COPD）是HIV感染者（PWH）面临的重要公共卫生问题。 在调整吸烟因素后，PWH患COPD的几率是未感染者的3倍。急性加重 COPD（AECOPD）是COPD发病率和死亡率的主要原因。考虑到 AECOPD的预防和管理的国际实践指南一般存在于 人口有限的证据表明，HIV感染与AECOPD风险增加相关，但数据 艾滋病毒感染对AECOPD后结局的影响缺乏研究。我们也缺乏COPD的质量数据 威尔斯亲王医院的护理或护理过程与结果之间的关系。K 08的科学目标是 确定：1）PWH和未感染人群中AECOPD的风险因素; 2）HIV感染对结局的影响 AECOPD后; 3）HIV感染对COPD治疗的影响与指南的一致性以及 PWH中COPD护理质量和结局之间的关系。假设：1）HIV感染，“传统”AECOPD 危险因素和HIV特异性因素与AECOPD相关，年龄，吸烟， 和控制不佳的HIV感染，增加了对AECOPD的易感性; 2）HIV感染与 AECOPD后再入院率和死亡率增加; 3）指南一致性检查和治疗不足， 与未感染的人相比，PWH中的得分和高质量的COPD护理与改善的外 在PWH。我们将在一项艾滋病毒感染者和未感染者对照组的队列研究中验证我们的假设， 来自美国各地卫生系统的行政和电子健康记录（EHR）数据， 使用巢式病例对照抽样随机选择对照和逆概率处理的框架 加权进行分析，从而模拟以HIV感染为“治疗”的靶向试验。这项研究的数据将奠定 候选人未来R 01提案的基础，以评估患者对COPD治疗的依从性， 测试干预措施，以优化患者、提供者和系统层面的COPD护理。通过综合列车- 密集的指导，教学课程，体验式研究和学术活动的计划，坎迪， Date将实现他的职业发展目标，发展以下方面的专业知识：1）健康信息学和数据科学 用于分析行政和EHR数据; 2）分层和纵向统计建模; 3）因果推断- 从观察数据中获取信息; 4）领导、沟通和知识传播技能。再- 候选人导师的来源和经验（艾莉森·莫里斯博士、凯蒂·苏达博士和斯科特·罗森伯格博士）， 匹兹堡大学的支持性研究环境，以及来自 肺部，过敏和重症监护医学部确保成功执行拟议的 研究和培训活动以及候选人向独立的相对有效性的过渡， 健康服务研究者为威尔斯亲王医院的高质量COPD护理制定有效的管理策略。

PROJECT SUMMARY AND ABSTRACT Chronic obstructive pulmonary disease (COPD) is an important public health problem in people with HIV (PWH). PWH have 3-fold the odds of COPD as uninfected people after adjusting for smoking. Acute exacerbations of COPD (AECOPD) are the principal contributor to COPD morbidity and mortality. Given the adverse effects of AECOPD, international practice guidelines for the prevention and management of AECOPD exist in the general population. Limited evidence suggests that HIV infection is associated with increased risk for AECOPD, but data on the effect of HIV infection on post-AECOPD outcomes are lacking. We also lack data on quality of COPD care or the relationship between processes of care and outcomes in PWH. Scientific aims of this K08 are to determine: 1) risk factors for AECOPD in PWH and uninfected people; 2) the effect of HIV infection on outcomes after AECOPD; 3) the effect of HIV infection on COPD treatment concordance with guidelines and the relation- ship between COPD care quality and outcomes in PWH. Hypotheses: 1) HIV infection, “traditional” AECOPD risk factors, and HIV-specific factors are associated with AECOPD with interaction effects between age, smoking, and poorly controlled HIV infection that enhance susceptibility to AECOPD; 2) HIV infection is associated with increased readmissions and mortality after AECOPD; 3) guideline-concordant tests and therapies are underpre- scribed in PWH compared to uninfected people and high-quality COPD care is associated with improved out- comes in PWH. We will test our hypotheses in a cohort study of HIV-infected and uninfected controls with ad- ministrative and electronic health record (EHR) data from health systems across the US in a causal inference framework using nested case-control sampling to randomly select controls and inverse probability treatment weighting for analysis, thus emulating a target trial with HIV infection as “treatment.” Data from this study will lay the groundwork for the candidate’s future R01 proposals to assess patient adherence to COPD therapies and to test interventions to optimize COPD care at the patient, provider, and system level. Through an integrated train- ing plan of intensive mentorship, didactic coursework, experiential research, and academic activities, the candi- date will accomplish his career development goals to develop expertise in: 1) health informatics and data science for analysis of administrative and EHR data; 2) hierarchical and longitudinal statistical modeling; 3) causal infer- ence from observational data; and 4) leadership, communication, and knowledge dissemination skills. The re- sources and experiences of the candidate’s mentors (Drs. Alison Morris, Katie Suda, and Scott Rothenberger), supportive research environment at the University of Pittsburgh, and strong institutional commitment from the Division of Pulmonary, Allergy, and Critical Care Medicine assure the successful execution of the proposed research and training activities and the candidate’s transition into an independent comparative effectiveness and health services investigator developing effective management strategies for high-quality COPD care in PWH.