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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要患者报告结果 (PRO) 已纳入 UAB HIV 诊所的常规护理中，以监测抑郁症和物质使用障碍 (SUD)，如果不治疗，这些疾病会威胁艾滋病毒的进展 PRO 可以根据提供者的文件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。即使对于及时诊断的患者，仍然需要额外的治疗，特别是在农村和南部障碍地区获得 MH 和成瘾治疗提供者机会有限的州已被有效地用于将医疗服务扩大到农村和贫困地区然而，对于最佳医疗服务仍然存在知识差距。现实世界中创新技术（PRO、远程医疗）的实施策略和有效性为了解决这一差距，研究人员将利用阿拉巴马州质量管理小组 (AQMG)，这是一个 Ryan White HIV/AIDS 计划 (RWHAP) 资助的阿拉巴马州诊所联盟于 2006 年成立。通过有效的 PRO 提出多成分干预、艾滋病毒+服务提供和远程医疗 (+STEP)，根据 Gelberg 的说法，增加 AQMG 站点对抑郁症和 SUD 的筛查和治疗。弱势群体的行为模型，通过解决 (1) 易感因素来优化健康结果 MH 和物质使用障碍等因素；(2) 个人和社区资源等促成因素； (3) 健康行为，例如使用医疗服务，+STEP 干预将利用这些领域来解决。 PRO 可以更准确地诊断抑郁症和 SUD（易感性），向一线提供有针对性的知识我们建议（启用）并使用远程医疗来扩展 MH 和 SUD 资源（健康行为）。一项混合 1 型设计研究，用于评估该多组件的实施和有效性我们将使用综合实施框架。研究（CFIR）以确定实施策略并指导实施、扩大和维护 +STEP。我们的主要目标是描述患者和诊所的接受情况，创建实施蓝图；障碍、促进因素和实施策略；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 的诊断和治疗位于阿拉巴马州的 6 个 RWHAP 诊所。目标 2. 描述解决六个 RWHAP 诊所采用 +STEP 障碍的实施策略，使用 CFIR。目标 3. 衡量实施 +STEP 对与以下相关的诊断、转诊和医疗保健利用的影响通过将接受 +STEP 的患者的临床结果与历史对照进行比较，得出抑郁症、SUD 和 HIV 的检测结果。预期结果是一个实施蓝图和现实世界的结果，以供广泛参考实施+STEP，以加速艾滋病毒连续性进程，最终结束艾滋病毒流行。