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

艾滋病毒感染者（PLWH）使用目前的抗逆转录病毒治疗寿命更长;然而， 日益老龄化的人口受到多种慢性病（MCC）的沉重负担， 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。 艾滋病毒提供者必须在时间有限的诊所就诊的情况下越来越优先考虑和解决MCC。我们 已经发现计算机化的，基于平板电脑的，自我管理的患者报告的测量和结果（PRO）， 由患者在门诊访视开始时填写，并立即提供给临床医生， 改善对诸如药物滥用和抑郁症等状况的检测， 组织临床问题的讨论。然而，到目前为止，我们一直局限于使用一种方法， PRO评估缺乏提供者关于治疗患者的最临床相关优先级的输入 关于MCC在当前的临床护理环境中，优先顺序对于PRO的成功尤为重要; 必须简化PRO评估，以最大限度地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。综合临床系统的CFAR研究网络（CNICS），一个跨8个 美国在HIV护理中常规管理PRO并在治疗期间向提供者提供PRO反馈的研究中心 目前的访问（超过70，000评估完成日期），是独特的定位，以确定临床优先事项， 艾滋病毒提供者和艾滋病毒携带者，并制定和实施动态个性化的PRO评估， 个人治疗需要。我们会1）为每名艾滋病毒携带者确定主要的慢性病和临床优先事项， 与MCC一起采访艾滋病毒护理提供者和PLWH; 2）创建算法以优先考虑反映 确定的条件、优先事项和价值以及临床护理可用的时间; 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- 在CNICS研究中心的常规临床护理中，对患有慢性疾病的PLWH进行特定PRO收集 美国; 5)评估整合个性化PRO作为创新医疗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确定的慢性疾病相关问题的处方和转诊。 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一起采取措施照顾艾滋病毒携带者。使用个性化的算法方法来进行域选择， 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， 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，并使其能够融入护理。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医疗记录中。由此产生的现代化PRO工具 将改善以患者为中心的综合护理PLWH与MCC。

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.