HIV+ Service delivery and Telemedicine through Effective PROs

通过有效的 PRO 提供艾滋病毒服务和远程医疗

• 批准号: 10475677
• 负责人: Ellen Florence Eaton
• 金额: $ 66.27万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10475677
• 关键词: AIDS/HIV problem; Address; Adherence; Affect; Alabama; Annual Reports; Anti-Retroviral Agents; Behavioral Model; Caring; Characteristics; Client; Clinic; Clinical; Communities; Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Diagnosis; Diagnostic; Documentation; Effectiveness; Enabling Factors; Epidemic; Face; Funding; HIV; Health; Health Personnel; Health Services Research; Health behavior; Individual; Intervention; Knowledge; Maintenance; Measures; Medicaid; Medical; Mental Depression; Mental Health; Mental Health Services; Monitor; Needs Assessment; Outcome; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Penetrance; Persons; Population; Poverty Areas; Predisposing Factor; Prevention; Provider; Readiness; Reporting; Research; Research Design; Research Personnel; Resources; Rural; Screening procedure; Services; Site; Standardization; Stretching; Substance Use Disorder; Telemedicine; Testing; Time; Training; United States Health Resources and Services Administration; Universities; Viral; Viral Load result; Visit; Vulnerable Populations; accurate diagnosis; addiction; comorbidity; diagnostic accuracy; effectiveness evaluation; experience; health care service utilization; hybrid type 1 design; implementation evaluation; implementation outcomes; implementation science; implementation strategy; improved; information gathering; innovative technologies; intervention effect; medical specialties; multi-component intervention; novel; population health; programs; psychosocial; routine care; rural area; rurality; scale up; screening; service delivery; tool; treatment adherence; uptake

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.

项目摘要 患者报告的结果（PRO）已在UAB HIV诊所的常规护理中纳入 监测抑郁症和药物使用障碍（SUD），如果未经处理，则威胁到艾滋病毒的进展 护理继续。专业人士更准确地确定相对于提供者文档的这些合并条件。 这是专业人士使诊所能够为最需要的人分配稀缺的心理健康（MH）和SUD服务。 即使对于及时诊断的患者，尤其是在农村和南部的患者，还有其他治疗障碍 获得MH和成瘾治疗提供者的国家。远程医疗已有效地用于 将医疗保健扩展到粗糙而贫穷的地区。但是，关于最佳的知识差距 现实世界中创新技术的实施策略和有效性（PROS，远程医疗） 设置。为了解决这一差距，调查人员将利用阿拉巴马州质量管理小组（AQMG），一个 Ryan White HIV/AIDS计划（RWHAP）在阿拉巴马州成立的诊所成立于2006年。 通过有效的专业人士提出多组分干预，HIV+服务提供和远程医疗 （+步骤），以增加AQMG部位抑郁和SUD的筛查和治疗。根据盖尔伯格的说法 弱势群体的行为模型，通过解决（1）易感性来优化健康结果 MH和药物使用障碍等因素； （2）启用个人和社区资源等因素； （3）健康行为，例如使用医疗服务。 +步骤干预将使用 更准确地诊断抑郁症和SUD（易感性）的优点，有针对性的知识 临床医生（支持），并使用远程医疗扩大MH和SUD资源（健康行为）。我们建议 一项混合型1设计研究，以评估该多组分的实施和有效性 干预（专业，培训和远程医疗）。我们将使用合并的框架进行实施 研究（CFIR）确定实施策略并指导实施，扩展和维护 +步骤。我们的主要目标是表征患者和诊所的吸收；创建实现蓝图 障碍，促进者和实施策略；并通过以下目的评估有效性： 目标1。进行需求评估和实施 +步骤以改善MH和SUD的诊断和治疗 在阿拉巴马州的6个R Whap诊所。 目的2。描述实施策略，以解决六个RWHAP诊所中 +spep的障碍的实施策略 CFIR。 目标3。衡量实施 +步骤对诊断，转诊和医疗保健利用的影响 通过比较接受 +步骤的患者与历史控制的患者的临床结果，抑郁，SUD和HIV。 预期的结果是实施蓝图和现实结果，以告知广泛 实施 +步骤，以加速沿HIV连续体的进展，以结束HIV流行。