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

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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.