HIV+ Service delivery and Telemedicine through Effective PROs

项目摘要 患者报告结局（PRO）已被纳入UAB HIV诊所的常规护理， 监测抑郁症和物质使用障碍（SUD），如果不加以治疗，会威胁到艾滋病毒的沿着进展 关怀连续体相对于提供者文档，PRO更准确地识别这些合并症。 因此，PRO使诊所能够将稀缺的心理健康（MH）和SUD服务分配给最需要的人。 即使对及时诊断的患者，特别是在农村和南部地区， 州获得MH和成瘾治疗提供者的机会有限。远程医疗已被有效地用于 扩大医疗卫生向农村和贫困地区延伸。然而，关于最佳选择的知识差距仍然存在。 创新技术（PRO、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，调查人员将利用亚拉巴马质量管理小组（AQMG）， 瑞安白色艾滋病毒/艾滋病计划（RWHAP）的财团资助的诊所在亚拉巴马，成立于2006年。我们 建议通过有效的PRO进行多方面干预、艾滋病毒+服务提供和远程医疗 （+STEP），以增加AQMG站点中抑郁症和SUD的筛查和治疗。根据Gelberg的 弱势群体的行为模型，通过解决以下问题来优化健康结果：（1） （2）个人和社区资源等有利因素; （3）使用医疗服务等健康行为。+ STEP干预将通过以下方式解决这些领域的问题： PRO更准确地诊断抑郁症和SUD（诱发），有针对性地了解前线 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）。我们提出 混合1型设计研究，以评估该多组件的实施和有效性 干预（PRO、培训和远程医疗）。我们将利用《综合执行框架》 研究（CFIR），以确定实施战略，并指导实施，扩大和维护 + STEP。我们的主要目标是描述患者和诊所的使用情况;创建实施蓝图 障碍、促进因素和实施战略;并通过以下目标评估有效性： 目标1。进行需求评估并实施+STEP，以改善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解决障碍的实施策略 CFIR。 AIM 3.衡量实施+STEP对诊断、转诊和医疗保健利用率的影响， 抑郁症，SUD和艾滋病毒通过比较临床结果从患者接受+STEP与历史对照。 预期成果是一个实施蓝图和现实世界的成果，以告知广泛的 执行"加强艾滋病毒/艾滋病防治措施"，以加快在艾滋病毒防治方面的进展，沿着艾滋病毒防治的连续性，最终结束艾滋病毒的流行。

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.