HIV+ Service delivery and Telemedicine through Effective PROs

项目总结 患者报告的结果(PRO)已整合到UAB HIV诊所的常规护理中，以 监测抑郁症和物质使用障碍(SUD)，如果不进行治疗，会威胁到艾滋病毒的进展 护理连续体。与提供商文档相比，专业人员可以更准确地识别这些并存情况。 因此，PRO使诊所能够将稀缺的精神卫生(MH)和SUD服务分配给最需要的人。 即使对诊断及时的患者，特别是在农村和南部，仍存在额外的治疗障碍 接触MH和成瘾治疗提供者的机会有限的国家。远程医疗已被有效地用于 将医疗服务扩大到农村和贫困地区。然而，关于最优的知识差距仍然存在。 创新技术(专业技术、远程医疗)在现实世界中的实施战略和有效性 设置。为了解决这一差距，调查人员将利用阿拉巴马州质量管理组织(AQMG)，一个 瑞安·怀特艾滋病毒/艾滋病项目(RWHAP)资助的阿拉巴马州诊所联盟，成立于2006年。我们 通过有效的专业人员提出多成分干预、艾滋病毒+服务提供和远程医疗 (+STEP)，增加对AQMG部位抑郁症和SUD的筛查和治疗。根据盖尔伯格的 脆弱人群的行为模型，通过解决(1)易感问题来优化健康结果 MH和物质使用障碍等因素；(2)个人和社区资源等促成因素； (3)使用医疗服务等健康行为。+STEP干预将使用以下方式解决这些领域 专业人士更准确地诊断抑郁症和SUD(易感)，有针对性的知识到一线 临床医生(使能)，以及使用远程医疗来扩大MH和SUD资源(健康行为)。我们建议 用于评估该多组件的实施和有效性的混合型1设计研究 干预(专业人员、培训和远程医疗)。我们将使用综合框架来实施 研究(CFIR)以确定实施战略并指导实施、扩展和维护 +踏步。我们的主要目标是确定患者和临床应用的特征；创建实施蓝图 确定障碍、促进者和执行战略；并通过以下目标评估成效： 目标1.进行需求评估并实施+步骤，以改进MH和SUD的诊断和治疗 在阿拉巴马州的6个RWHAP诊所。 目标2.描述在六个RWHAP诊所使用+STEP解决采用+STEP障碍的实施策略 CFIR。 目标3.衡量实施+STEP对以下方面的诊断、转诊和医疗保健利用的影响 通过比较接受+STEP治疗的患者和历史对照组的临床结果，发现抑郁症、SUD和HIV。 预期结果是实施蓝图和实际结果，可供广泛了解 实施+步骤，以加快艾滋病毒连续体在结束艾滋病毒流行方面的进展。

PROJECT SUMMARY Patient-reported Outcomes (PROs) have been integrated into routine care at the UAB HIV Clinic to monitor depression and substance use disorders (SUD) that, when untreated, threaten progress along the HIV care continuum. PROs more accurately identify these comorbid conditions relative to provider documentation. Thus, PROs enable clinics to allocate scarce mental health (MH) and SUD services to those in greatest need. Additional treatment barriers remain even for patients with prompt diagnoses, especially in rural and Southern states with limited access to MH and addiction treatment providers. Telemedicine has been effectively used to expand medical care to rural and impoverished areas. Yet, there remains a knowledge gap about optimal implementation strategies for and effectiveness of innovative technologies (PROs, telemedicine) in real-world settings. To address this gap, investigators will leverage the Alabama Quality Management Group (AQMG), a consortium of Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Alabama, founded in 2006. We propose a multicomponent intervention, HIV+ Service delivery and Telemedicine through Effective PROs (+STEP), to increase screening and treatment of depression and SUD in AQMG sites. According to Gelberg’s Behavioral Model for Vulnerable Populations, health outcomes are optimized by addressing (1) predisposing factors like MH and substance use disorders; (2) enabling factors such as personal and community resources; and (3) health behaviors like use of medical services. The +STEP intervention will address these domains using PROs to more accurately diagnose depression and SUD (predisposing), targeted knowledge to frontline clinicians (enabling), and use of telemedicine to expand MH and SUD resources (health behavior). We propose a hybrid type 1-design study to evaluate the implementation and effectiveness of this multicomponent intervention (PROs, training, and telemedicine). We will use the Consolidated Framework for Implementation Research (CFIR) to identify implementation strategies and guide implementation, scale up, and maintenance of +STEP. Our principle objectives are to characterize patient and clinic uptake; create an implementation blueprint of barriers, facilitators and implementation strategies; and evaluate effectiveness through the following aims: Aim 1. Conduct a needs assessment and implement +STEP to improve diagnosis and treatment of MH and SUD at 6 RWHAP clinics in Alabama. Aim 2. Describe implementation strategies addressing barriers to uptake of +STEP in six RWHAP clinics using CFIR. AIM 3. Measure the impact of implementing +STEP on diagnoses, referrals, and healthcare utilization related to depression, SUD, and HIV by comparing clinical outcomes from patients receiving +STEP with historical controls. The expected outcomes are an implementation blueprint and real-world outcomes to inform broad implementation of +STEP to accelerate progress along the HIV continuum towards ending the HIV Epidemic.