Implementation and Evaluation of psPRO: Person-specific Patient-Reported Outcome Assessments for Patients in HIV Care living with Multiple Chronic Conditions

使用当前的抗逆转录病毒治疗，艾滋病毒感染者（PLWH）的寿命会更长；然而，这 日益老龄化的人口承受着多种慢性病（MCC）的沉重负担，包括糖尿病、 精神疾病、成瘾和其他可能影响功能、症状负担和结果的疾病。 在时间有限的就诊情况下，艾滋病毒提供者必须更加优先考虑并解决 MCC。我们 发现了计算机化、基于平板电脑、自我管理的患者报告措施和结果 (PRO)， 由患者在就诊开始时填写并立即提供给临床医生，显着 改善对药物滥用和抑郁等状况的检测，对提供者有价值 组织临床问题的讨论。然而，迄今为止，我们仅限于使用一种方法来 PRO 评估缺乏提供者对治疗患者的临床最相关优先事项的意见 与中冶集团。优先顺序对于 PRO 在当前临床护理环境中的成功尤其重要； 必须简化 PRO 评估，以尽量减少对诊所流程的影响并最大限度地提高与提供者的相关性 和病人。 CFAR 综合临床系统研究网络 (CNICS)，是一个由 8 个组织组成的联盟 在 HIV 护理中定期管理 PRO 并在治疗期间向提供者提供 PRO 反馈的美国站点 目前的访问（迄今为止已完成超过 70,000 项评估），具有独特的优势来确定临床优先事项 HIV 提供者和 PLWH，并制定和实施动态个性化的 PRO 评估，以 个别治疗需要。我们将 1) 通过以下方式确定每个 PLWH 的关键慢性病和临床重点： 与 MCC 访谈艾滋病毒护理人员和艾滋病毒感染者； 2) 创建算法来优先考虑反映以下情况的 PRO 确定的条件、优先事项和价值观以及临床护理中可用的时间； 3) 与患者合作 提供者设计反映个人临床优先事项的 PRO 反馈； 4）实施实时人员 将患有慢性病的 PLWH 的特定 PRO 收集纳入 CNICS 各地点的常规临床护理中 美国； 5) 评估将个性化 PRO 集成为创新健康 IT 战略的有效性 改善护理； 6) 在 CNICS 中进行随机试验以比较临床文件和行动，例如， 提供者针对 PRO 发现的慢性病相关问题的处方和转介。这个提议 解决 RFA 目标，重点关注实施 PRO 的卫生 IT 战略的创新组成部分 与 MCC 一起照顾 PLWH 的措施。使用个性化算法方法进行域选择， 结合临床优先事项，并利用我们广泛的 CNICS 基础设施和 PRO 平台，这 项目确定/优先考虑与治疗 PLWH 中 MCC 最相关的领域，同时最大限度地减少患者 负担并能够融入护理。该方法和算法将推广到 PRO 系统 越来越多地出现在商业电子病历中或与商业电子病历一起出现。由此产生的现代化 PRO 工具 将通过 MCC 改善对 PLWH 的以患者为中心的综合护理。

People living with HIV (PLWH) live much longer with current antiretroviral treatments; however, this increasingly aging population is heavily burdened by multiple chronic conditions (MCC) including diabetes, mental illness, addiction, and other conditions that may impact functioning, symptom burden, and outcomes. HIV providers must increasingly prioritize and address MCC in the context of a time-constrained clinic visit. We have found computerized, tablet-based, self-administered patient-reported measures and outcomes (PROs), completed by patients at the beginning of clinic visits and immediately available to clinicians, significantly improve detection of conditions such as substance abuse and depression and are valuable to providers for structuring discussions of clinical problems. However, to date, we have been limited to using an approach to PRO assessment that lacks provider input regarding the most clinically relevant priorities for treating patients with MCC. Prioritization is particularly relevant for the success of PROs in the current clinical care environment; PRO assessment must be streamlined to minimize impact on clinic flow and maximize relevance to providers and patients. The CFAR Research Network of Integrated Clinical Systems (CNICS), a consortium across 8 U.S. sites which routinely administers PROs in HIV care and delivers PRO feedback to providers during the current visit (>70,000 assessments completed to date), is uniquely positioned to identify the clinical priorities of HIV providers and PLWH, and to develop and implement PRO assessments dynamically personalized to individual treatment needs. We will 1) identify key chronic conditions and clinical priorities for each PLWH by interviewing HIV care providers and PLWH with MCC; 2) create algorithms to prioritize PROs that reflect the conditions, priorities, and values identified as well as time available in clinical care; 3) partner with patients and providers to design PRO feedback reflective of individual clinical priorities; 4) implement real-time person- specific PRO collection for PLWH with chronic conditions into routine clinical care at CNICS sites across the U.S.; 5) evaluate effectiveness of integrating personalized PROs as an innovative health IT strategy for improving care; 6) conduct a randomized trial in CNICS to compare clinical documentation and actions, e.g., prescriptions and referrals by providers for chronic condition-related issues identified by PROs. This proposal addresses RFA objectives focusing on innovative components of a health IT strategy for implementing PRO measures in care for PLWH with MCC. Using personalized algorithmic approaches to domain selection, incorporating clinical priorities, and leveraging our extensive CNICS infrastructure and PRO platform, this project identifies/prioritizes domains most relevant for treating MCC among PLWH while minimizing patient burden and enabling integration into care. The approach and algorithms will generalize to PRO systems increasingly found in and alongside commercial electronic medical records. The resulting modernized PRO tool will improve patient-centered comprehensive care for PLWH with MCC.