Developing an HIV-Specific Prevention Index Using the Electronic Medical Record

描述（由申请人提供）：本申请是根据PA-09-070，AHRQ卫生服务研究项目（R 01）提交的。新疗法正在延长艾滋病毒感染者的预期寿命，反过来，他们所接受的医疗保健质量的重要性也在增加。这项研究将评估艾滋病毒治疗提供者成功的临床护理（反映在遵守推荐的预防和筛查指南）与护理质量和结果之间的关联程度，该样本为西北部和加州的4,000名艾滋病毒感染Kaiser Permanente（KP）患者。具体项目目标包括：1.制定新的综合护理质量措施，用于管理艾滋病毒感染者。1a.使用KP电子医疗记录和数据系统，计算患者接受各种建议的一般预防和艾滋病毒特定服务的时间相对于患者符合保险条件的时间的比例-“艾滋病毒预防指数”，量化遵守建议的预防保健服务既定标准的情况。1b.计算艾滋病病毒感染者在与艾滋病病毒管理相关的各种临床措施-“疾病管理指数-艾滋病病毒”（DMIH）的既定标准范围内的程度。我们将在最初的HIV诊断后计算多个12个月的PIH和DMIH。除了服务特定的PIH和DMIH，我们的目标是为一组代表性的服务和措施，被认为是重要的照顾艾滋病毒感染者的PIH和DMIH摘要。2.检查目标1中的护理质量指标与临床结局的相关性。2a.评估估计的特定服务和总结PIH和DMIH跨年的时间趋势，以评估HIV患者的护理质量，调整HIV护理的长期趋势。2b.评估Dx后12个月PIH和DMIH水平是否较高，可预测最新高效抗逆转录病毒治疗方案的使用，此类方案的依从性和/或变化，以及选定HIV相关结局的变化。3.研究实践变异与制定的护理质量措施之间的关联。3a.探讨不同的提供者特征如何导致实践差异，从而影响PIH和DMIH。由经验丰富的卫生服务研究人员和艾滋病毒临床专家组成的研究小组将使用KP的电子病历和数据系统来探索和描述一般临床护理与结果的关联。我们希望我们的研究结果，以提高对艾滋病毒患者的护理质量和结果的初级保健实践的特点的影响的理解。 公共卫生相关性：正在制定反映艾滋病毒护理范围的质量绩效措施，包括艾滋病毒疾病的检测和诊断、获得护理和后续行动的机会、适当使用抗逆转录病毒疗法和机会性感染预防，以及对接受抗逆转录病毒疗法的患者的结果措施。以及需要更系统的干预措施来改善艾滋病毒感染者的健康维护。

DESCRIPTION (provided by applicant): This application is submitted in response to PA-09-070, AHRQ Health Services Research Projects (R01). New therapies are increasing the life expectancy for patients with HIV and, in turn, the importance of the quality of the health care they receive. This study will assess the degree of association between successful clinical care by HIV treatment providers (reflected in adherence to recommended prevention and screening guidelines) and quality of care and outcomes for a sample of 4,000 HIV-infected Kaiser Permanente (KP) patients in the Northwest and California. Specific project aims include: 1. Develop new composite quality of care measures for use in the management of patients infected with HIV. 1a. Using KP electronic medical records and data systems, calculate the proportion of patient time covered by receipt of various recommended general preventive and HIV-specific services, relative to the time during which patients were coverage-eligible-the "Prevention Index-HIV" (PIH), quantifying adherence to established standards for recommended preventive health services. 1b. Calculate the degree to which patients with HIV are within established standards for various clinical measures relevant to HIV management-the "Disease Management Index-HIV" (DMIH). We will calculate a PIH and DMIH for multiple 12-month periods following initial HIV diagnosis. In addition to service-specific PIHs and DMIHs, our objective is to produce a summary PIH and DMIH for a representative set of services and measures considered important to the care of patients with HIV. 2. Examine the association of the quality of care measures from Aim 1 with clinical outcomes. 2a. Assess the temporal trend of the estimated service-specific and summary PIHs and DMIHs across years to evaluate the quality of care for patients with HIV, adjusting for secular trends in HIV care. 2b. Assess whether higher levels of the 12-month post-dx PIHs and DMIHs, predict use of the latest highly active anti-retroviral therapy regimens, adherence to and/or changes in such regimens, and changes in selected HIV-related outcomes. 3. Study the association of practice variation with the developed quality of care measures. 3a. Explore how different provider characteristics induce practice variation, and thus affect the PIH and DMIH. The study team of experienced health services researchers and HIV clinical experts will use KP's electronic medical record and data systems to explore and describe the association of general clinical care with outcomes. We expect our results to improve understanding of the influence of primary care practice characteristics on the quality of care and outcomes for patients with HIV. PUBLIC HEALTH RELEVANCE: Quality performance measures are being developed that reflect the spectrum of HIV care, including testing for and diagnosis of HIV disease, access to care and follow-up, appropriate use of antiretroviral therapy (ART) and opportunistic infection prevention, and outcome measures for patients prescribed ART. The results of this study will show where both general health prevention and HIV-related health prevention are deficient, and where more systematic interventions to improve health maintenance among HIV-infected patients are needed.