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

艾滋病毒携带者(PLWH)使用目前的抗逆转录病毒治疗可以活得更长；然而，这 日益老龄化的人口受到包括糖尿病在内的多种慢性病(MCC)的沉重负担， 精神疾病、成瘾和其他可能影响功能、症状负担和结果的情况。 艾滋病毒提供者必须在时间有限的诊所访问的背景下，越来越优先地处理MCC。我们 发现了计算机化的、基于平板电脑的、自我管理的患者报告的测量和结果(PRO)， 由患者在开始就诊时完成，并立即提供给临床医生，显著 改进对药物滥用和抑郁等情况的检测，并对提供者有价值 组织临床问题的讨论。然而，到目前为止，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最具临床相关性的优先事项的意见 与MCC合作。优先顺序对专业人员在当前临床护理环境中的成功特别相关； 必须简化专业评估，以最大限度地减少对诊所流量的影响，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个国家组成的联盟 美国网站，这些网站定期管理艾滋病护理专业人员，并在 当前访问(迄今已完成70,000项评估)，具有独特的地位，可以确定以下患者的临床优先事项 艾滋病毒提供者和PLWH，并制定和实施动态个性化的PRO评估 个体化治疗需要。我们将1)确定每个PLWH的关键慢性病和临床优先事项 与MCC一起采访艾滋病毒护理人员和PLWH；2)创建算法，以确定专业人员的优先顺序，以反映 临床护理中确定的条件、优先事项和价值以及可用的时间；3)与患者和 提供者设计反映个人临床优先事项的专业反馈；4)实施实时人- 将慢性病患者的特殊PRO收集纳入CNICS网站的常规临床护理 美国；5)评估将个性化专业人员整合为创新的医疗IT战略的有效性 改善护理；6)在CNICs中进行随机试验，以比较临床文献和行动，例如， 由专业人士确定的慢性疾病相关问题的提供者的处方和转介。这项建议 解决RFA目标，重点关注实施PRO的医疗IT战略的创新组件 合并MCC的PLWH的护理措施。使用个性化算法方法来选择域， 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 该项目确定/优先处理PLWH中与治疗MCC最相关的领域，同时最大限度地减少患者 负担，并使之能够融入护理。该方法和算法将推广到PRO系统 越来越多的人在商业电子病历中和商业电子病历一起使用。由此产生的现代化专业工具 将通过MCC改善以患者为中心的PLWH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.