Electronic Health Record-Based Dementia Prediction for HIV Primary Care

项目摘要 Jennifer Lam博士，公共卫生硕士是一位传染病流行病学家，其研究重点是改善 老年艾滋病毒感染者的健康。她先前的研究探讨了慢性疾病对人的影响， 艾滋病毒携带者她最近将她的工作扩展到艾滋病毒背景下的痴呆症评估 感染越来越多的证据表明，艾滋病毒感染者的衰老经历了一个独特的认知轨迹， 尽管接受了抗逆转录病毒治疗，但病情仍有所下降。这可能是由于艾滋病毒介导的 炎症和非HIV因素，如物质使用、精神共病和心血管疾病。 由于美国的许多艾滋病毒感染者现在都超过50岁，与年龄相关的痴呆症将成为一种严重的疾病。 日益严重的健康问题。到目前为止，很少有研究描述老年人痴呆症的特征， 艾滋病毒感染得到很好的控制。拟议的研究旨在：1）量化社会人口的贡献， 行为和共病相关因素与50岁以上HIV感染者痴呆风险的关系， 2）开发和验证一个模型来预测艾滋病毒感染者的痴呆事件，使用 电子健康记录数据，并纳入艾滋病毒感染的严重程度和持续时间等艾滋病毒特异性因素， 以及3）开发策略以优化痴呆预测模型的临床效用。一个主要的优势， 拟议的研究是，最初的模型开发和验证将在一个大型医疗保健 这是一个具有良好特征的老年艾滋病毒感染者和稳定的纵向随访的系统。这将是 然后在外部HIV队列中进行验证，以评估普遍性，开发原型临床医生- 面对风险分层工具，和利益相关者访谈，以获得未来临床实施的输入。小说 该研究的组成部分包括以社区为基础的人群样本中痴呆症风险的特征 与来自相同环境的未感染艾滋病毒的个体进行比较，并使用高级分析， 使用电子健康记录中的初级保健数据评估痴呆症的多个纵向预测因素。到 支持拟议的研究和林博士未来独立研究艾滋病毒和痴呆症的目标， K 01提案包括一个正式的、有指导的培训计划，以培养以下方面的技能：1）风险因素评估 对于HIV感染者的神经认知障碍，2）发展分析建模技术， 验证基于电子健康记录数据的痴呆预测模型，3）翻译和 将研究结果应用于临床护理环境; 4）专业技能发展。培训 将包括课程作业和量身定制的辅导，由一个具有艾滋病毒综合专业知识的导师团队提供， 神经学、衰老、生物统计学和医疗保健提供科学。拟议研究的结果将 为艾滋病毒感染者痴呆症预防提供信息战略，并支持实施和测试 痴呆风险分层工具在临床实践中的应用。这也将为林博士作为一个独立的职业生涯做好准备 美国国立卫生研究院资助的艾滋病毒感染者痴呆症预防和管理研究的研究人员。

PROJECT SUMMARY Jennifer Lam PhD, MPH is an infectious disease epidemiologist whose research focuses on improving the health of the aging HIV population. Her prior research has explored the impact of chronic disease on persons living with HIV. She has recently extended her work to the evaluation of dementia in the context of HIV infection. Mounting evidence suggests that people aging with HIV experience a unique trajectory of cognitive decline despite treatment with antiretroviral therapy. This may be due to the combined effects of HIV-mediated inflammation and non-HIV factors such as substance use, psychiatric comorbidity, and cardiovascular disease. As many people with HIV in the U.S. are now over 50 years old, age-associated dementias will become an increasingly critical health concern. To date, few studies have characterized dementia in older individuals with well-controlled HIV infection. The proposed research aims to: 1) quantify the contribution of sociodemographic, behavioral, and comorbidity-related factors to risk of dementia in people aged 50+ years with HIV compared to those without HIV, 2) develop and validate a model to predict incident dementia in people with HIV, using electronic health record data and incorporating HIV-specific factors such as HIV infection severity and duration, and 3) develop strategies to optimize the clinical utility of a dementia prediction model. A major strength of the proposed research is that initial model development and validation will be conducted within a large healthcare system with a well-characterized older population with HIV and stable, longitudinal follow-up. This will be followed by validation in an external HIV cohort to assess generalizability, development of a prototype clinician- facing risk stratification tool, and stakeholder interviews to obtain input on future clinical implementation. Novel components of the research include characterization of dementia risk in a community-based sample of people with HIV, comparison with HIV-uninfected individuals from the same setting, and use of advanced analytics to evaluate multiple longitudinal predictors of dementia using primary care data in electronic health records. To support the proposed research and Dr. Lam’s goal of future independent research in HIV and dementia, this K01 proposal includes a formal, mentored training program to develop skills in: 1) the evaluation of risk factors for neurocognitive disorders in people with HIV, 2) analytic modeling techniques for development and validation of electronic health record data-based dementia prediction models, 3) translation and implementation of research findings into clinical care settings, and 4) professional skills development. Trainings will consist of coursework and tailored tutorials delivered by a mentorship team with combined expertise in HIV, neurology, aging, biostatistics, and healthcare delivery science. The results of the proposed research will inform strategies for dementia prevention in people with HIV and support plans to implement and test a dementia risk stratification tool in clinical practice. It will also prepare Dr. Lam for a career as an independent investigator conducting NIH-funded research on prevention and management of dementia in people with HIV.