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（R01）提交的。新的治疗方法延长了艾滋病毒患者的预期寿命，进而提高了他们接受的医疗保健质量的重要性。本研究将评估艾滋病毒治疗提供者的成功临床护理（反映在对推荐的预防和筛查指南的遵守情况）与护理质量和结果之间的关联程度，该样本为西北和加利福尼亚的4,000名感染了Kaiser Permanente （KP）的艾滋病毒患者。具体项目目标包括：1。制定新的综合护理质量措施，用于艾滋病毒感染者的管理。1一个。利用KP电子医疗记录和数据系统，计算患者接受各种推荐的一般预防服务和艾滋病毒特异性服务所占时间的比例，相对于患者符合“艾滋病毒预防指数”（PIH）覆盖条件的时间，量化对推荐的预防保健服务既定标准的遵守情况。1 b。计算艾滋病毒患者在与艾滋病毒管理有关的各种临床措施的既定标准内的程度-“疾病管理指数-艾滋病毒”（DMIH）。我们将计算初始HIV诊断后12个月期间的PIH和DMIH。除了特定服务的PIH和DMIH外，我们的目标是为艾滋病毒患者的护理提供一套具有代表性的服务和措施的PIH和DMIH摘要。2. 检查目的1中护理措施的质量与临床结果的关系。2 a。评估多年来估计的特定服务和汇总pih和dmih的时间趋势，以评估艾滋病毒患者的护理质量，并根据艾滋病毒护理的长期趋势进行调整。2 b。评估12个月后pih和dmih水平是否较高，预测最新高活性抗逆转录病毒治疗方案的使用，对这些方案的依从性和/或改变，以及选定的艾滋病毒相关结果的变化。3. 研究实践变化与发展的护理质量措施之间的关系。3 a。探讨不同的提供者特征如何引起实践差异，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系。我们期望我们的结果能够提高对初级保健实践特征对艾滋病毒患者的护理质量和结果的影响的理解。

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.