Project CONNECT: Connecticut Public Health Partnerships - Promoting Continuity o

项目 CONNECT：康涅狄格州公共卫生合作伙伴关系 - 促进连续性

• 批准号: 8792315
• 负责人: Heidi Jenkins
• 金额: $ 10万
• 依托单位: CONNECTICUT STATE DEPT OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8792315
• 关键词: Project; CONNECT; Connecticut; Public; Health

DESCRIPTION (provided by applicant): The HIV Continuum of Care Model proposes to characterize the engagement of persons living with HIV/AIDS (PLH) within healthcare systems. Only 28% of U.S. PLH have achieved viral suppression, but nearly half (49.1%) of PLH are out-of-care (OOC), based on ineffective linkage (23%) and retention in care (33.7%). In Connecticut, ~33% of 10,849 prevalent cases are believed to be OOC, defined as not having a pVL or CD4 in the past year and 83% and 93% of the 348 newly diagnosed cases in 2012 were linked to HIV within 3 and 12 months, respectively. Guidelines strongly recommend "systematic monitoring of successful entry into care for newly diagnosed individuals and retention in care for those who are linked with use of data sources including surveillance methods, medical records and clinic databases". Achieving systematic monitoring has been problematic due to varying definitions for linkage and retention in care that include clinic visits from electronic medical records (EMR) and/or laboratory surveillance data (CD4/pVL). Pilot studies suggest that surveillance data integrated with EMRs can be leveraged to improve linkage and retention in HIV medical care. Barriers to this approach include restrictive state laws related to sharing of confidential information, lack of provider support and patient perceptions of intrusion and coercion. To improve linkage and re-engagement in care, we propose Project CONNECT, a new CT partnership between the DPH and 93% of CT's HIV treatment sites (Ryan White A clinics (N=19), selected private clinics (N=4) and Yale University School of Medicine). This new multi-disciplinary team will create a new and innovative data monitoring system called CTLink which will integrate 3 independent databases: the eHARS surveillance database, clinical and administrative appointment databases, and an enhanced Ryan White CAREWare database. It will have capacity to more accurately define those who are truly out of care and report standardized measures of healthcare engagement. Evidence-based interventions (EBIs) will include an adapted ARTAS II intervention (Anti-Retroviral Treatment and Access to Services, a 5-session strengths-based case management approach) called ARTAS+. ARTAS+ will be adapted to DPH Disease Intervention Specialist (DIS) workers; it will harness mobile media and the strengths of our existing intensive outreach programs within Ryan White. It provides potential augmentation by adding a voucher-based lottery system for individuals who are linked, but not retained in care. Project CONNECT is highly innovative due to strong existing collaborations, creation of the comprehensive CTLink database that links surveillance and clinical care activities, use of EBIs that are adapted to be effective and cost-effective, the use f an adaptive study design and research partners with long-standing history of multi-site collaborations, including with the CDC, and a strong track record of publishing and disseminating their findings.

描述（由申请人提供）：护理模型的艾滋病毒连续体建议表征艾滋病毒/艾滋病（PLH）在医疗保健系统中的参与。只有28％的美国PLH基于无效的连锁（23％）和保留护理（33.7％），美国PLH已实现了病毒抑制，但近一半（49.1％）是护理（OOC）。在康涅狄格州，据信10,849例普遍病例中的约33％被认为是OOC，定义为在过去的一年中没有PVL或CD4，2012年在348例新诊断的病例中，有83％和93％在3和12个月内分别与HIV有关。指南强烈建议“系统地监测新诊断的个人的成功进入护理，并保留与使用数据源有关的人，包括监视方法，医疗记录和诊所数据库。”由于与电子病历（EMR）和/或实验室监视数据（CD4/PVL）的诊所访问的定义不同，因此实现系统监测的问题是有问题的。试点研究表明，与EMR集成的监视数据可以利用以改善艾滋病毒医疗保健中的联系和保留率。这种方法的障碍包括与共享机密信息共享，缺乏提供者支持以及患者对入侵和胁迫的看法有关的限制性州法律。为了提高关联和重新参与护理，我们提出了Connect Project Connect，这是DPH与CT HIV治疗地点的93％之间的新CT合作伙伴关系（Ryan White A诊所（n = 19），选定的私人诊所（n = 4）和耶鲁大学医学院）。这个新的多学科团队将创建一个称为CTLink的新的创新数据监视系统，该系统将集成3个独立的数据库：EHARS监视数据库，临床和行政预约数据库以及增强的Ryan White Careware数据库。它将有能力更准确地定义那些真正失去护理并报告标准化医疗保健参与度的人。基于证据的干预措施（EBIS）将包括改编的ARTA II干预措施（抗逆转录病毒治疗和获得服务，一种基于5条优势的案例管理方法），称为ARTAS+。 ARTA+将适用于DPH疾病干预专家（DIS）工人；它将利用移动媒体以及我们在瑞安·怀特（Ryan White）内现有的强化外展计划的优势。它通过为链接但未保留护理的个人添加基于优惠券的彩票系统来提供潜在的增强。项目Connect具有很高的创新性，这是由于现有的强大合作，创建了综合的CTLink数据库，该数据库将监视和临床护理活动联系起来，使用EBI，可适应有效且具有成本效益的EBI，使用自适应研究设计和研究伙伴与长期存在的伙伴与多站点合作的长期历史合作，以及与CDC的共同记录，以及cdc的持久记录，以及出现的出售和拼写式的销售和拼写。