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

项目摘要和摘要 慢性阻塞性肺疾病(COPD)是人类免疫缺陷病毒(HIV)感染者面临的重要公共卫生问题。 在调整吸烟因素后，PWH患COPD的几率是未感染的人的3倍。急性加重期 慢性阻塞性肺疾病(COPD)是COPD发病率和死亡率的主要贡献者。鉴于……的不利影响 AECOPD，预防和管理AECOPD的国际实践指南一般存在 人口。有限的证据表明，艾滋病毒感染与AECOPD风险增加有关，但数据 关于艾滋病毒感染对AECOPD后结局的影响的研究还很缺乏。我们也缺乏关于慢性阻塞性肺疾病质量的数据 护理或护理过程与威斯康星医院预后之间的关系。这款K08的科学目标是 确定：1)威斯康星医院和未感染人群中AECOPD的危险因素；2)艾滋病毒感染对预后的影响 AECOPD后；3)HIV感染对COPD治疗的影响与指南的一致性及其关系。 慢性阻塞性肺疾病的护理质量与威斯康星医院的预后之间的关系。假设：1)HIV感染，“传统”AECOPD 风险因素和HIV特异性因素与AECOPD相关，年龄、吸烟、 和控制不佳的艾滋病毒感染，这增加了对AECOPD的易感性；2)艾滋病毒感染与 AECOPD后再入院率和死亡率增加；3)指南一致性测试和治疗正在进行中 在威斯康星医院与未感染的人相比，高质量的COPD护理与改善OUT- 以威尔斯亲王医院为单位。我们将在一项关于HIV感染和未感染对照的队列研究中验证我们的假设。 来自美国各地卫生系统的管理和电子健康记录(EHR)数据的因果推断 采用嵌套病例对照抽样随机选择对照和逆概率处理的框架 加权以供分析，从而模拟将艾滋病毒感染作为“治疗”的目标试验。这项研究的数据将为 候选人未来的R01提案的基础是评估患者对COPD治疗的依从性和 测试干预措施，以在患者、提供者和系统层面优化COPD护理。通过一列综合列车- 在强化指导、授课、体验研究和学术活动的计划中，坎迪-卡普兰-- Date将实现他的职业发展目标，在以下方面发展专业知识：1)健康信息学和数据科学 用于管理和电子健康记录数据的分析；2)分层和纵向统计建模；3)因果推断-- 以及4)领导能力、沟通能力和知识传播能力。再一次- 候选人的导师(艾莉森·莫里斯博士、凯蒂·苏达博士和斯科特·罗斯伯格博士)的来源和经验， 匹兹堡大学的支持性研究环境，以及来自 肺、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过渡到独立的比较有效性和 健康服务调查员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.