Quality Outcomes for Patients with Drug Abuse and HIV

描述(由申请人提供)：这项申请提出了一个培训计划，以发展P.Todd Kortheis，医学，公共卫生硕士，成为一名独立的临床医生-科学家在药物滥用和艾滋病毒的调查。科萨伊斯博士是一名普通内科医生，专门护理艾滋病毒感染者。导师职业发展计划包括三个层次的方法：正式的课程工作，以增强他以前获得的技能，基础广泛的体验式学习计划，以及导师的临床研究经验。该计划的主要目标将是让科萨斯博士在所有方面实现作为临床研究员的独立。他获得这一奖项的教育目标是增进他对药物滥用理论和治疗的了解，并在定性和定量研究设计和分析方法方面获得先进的专业知识，同时保持他在与药物滥用患者有关的艾滋病毒治疗和预防问题方面的专业知识。他将在他的主要导师、药物滥用研究和政策中心主任Dennis McCarty博士以及OHSU医学教授和卫生服务研究员David Hickam博士、经验丰富的定性方法研究员Carla Green博士和加州大学洛杉矶分校医学副教授兼退伍军人管理艾滋病毒质量增强研究计划主任Steven Asch博士的指导下进行临床研究。国家艾滋病毒研究网络首席研究员Richard Moore博士和具有国家意义的HRSA特别项目首席研究员Ruth Finkelstein博士将确保数据的获取和对拟议目标的持续支持。拟议的研究重点是确定同时患有药物滥用和艾滋病毒感染的患者的高质量结果。虽然药物滥用和艾滋病毒感染都有有效的治疗方法，但它们对改善护理质量的影响仍不清楚，如抑制艾滋病毒病毒。我的理论是，同时患有药物滥用和艾滋病毒感染的患者通过结合医疗保健结构和患者特征来实现高质量的结果。我的中心假设是，在有药物滥用史的人中，较好的艾滋病毒护理质量总分与获得药物滥用治疗的机会、高水平的指导性护理以及集中整合的药物滥用治疗护理有关。为了验证这一假设，我的目标是进行三项研究，以(1)确定获得药物滥用治疗对艾滋病毒护理质量的影响，(2)确定指示护理对艾滋病毒结局的影响，以及(3)确定随着时间的推移，药物滥用和艾滋病毒护理综合对不同吸毒程度的人的艾滋病毒护理质量的影响。

DESCRIPTION (provided by applicant): This application proposes a training program to develop P. Todd Korthuis, MD, MPH into an independent clinician-scientist in investigations of drug abuse and HIV. Dr. Korthuis is a General Internist who specializes in caring for HIV-infected patients. The mentored career development plan consists of a three-tiered approach: formal coursework to augment his previously acquired skills, a broad-based experiential learning program, and a mentored clinical research experience. The primary goal of this program will be for Dr. Korthuis to achieve independence as a clinical investigator in all respects. His educational goals for this award are to advance his understanding of drug abuse theory and treatment and obtain advanced expertise in qualitative and quantitative research design and analysis methods while maintaining his expertise in HIV treatment and prevention issues pertinent to patients with drug abuse. He will conduct mentored clinical research under the direction of his primary mentor, Dr. Dennis McCarty, Director of the Center for Substance Abuse Research and Policy, and co-mentors Dr. David Hickam, Professor of Medicine and health services researcher at OHSU, Dr. Carla Green, an experienced qualitative methods researcher, and Dr. Steven Asch, Associate Professor of Medicine at UCLA and director of the Veteran's Administration HIV Quality Enhancement Research Initiative. Dr. Richard Moore, principal investigator of the national HIV Research Network, and Dr. Ruth Finkelstein, principal investigator of the HRSA Special Projects of National Significance Integrated Buprenorphine and HIV Care Evaluation and Support Center will assure data access and continued support for the proposed aims. The proposed research focuses on identifying quality outcomes for patients with co-occurring drug abuse and HIV infection. Though effective treatments exist for both drug abuse and HIV infection, their impact on improving quality of care outcomes like HIV viral suppression remains unclear. I theorize that patients with co-occurring drug abuse and HIV infection achieve quality outcomes through a combination of healthcare structural and patient characteristics. My central hypothesis is that among persons with a history of drug abuse, better HIV quality of care summary scores are associated with access to drug abuse treatment, high levels of indicated care, and centrally integrated drug abuse treatment care. To test this hypothesis, I aim to conduct three studies to (1) determine the effect of access to drug abuse treatment on HIV quality of care, (2) determine the effect of indicated care on HIV outcomes, and (3) determine the effect of integrated drug abuse and HIV care on HIV quality of care among persons with varying degrees of drug use over time.