Use of antiretroviral therapy in older people with HIV during care transition

在护理过渡期间对感染艾滋病毒的老年人使用抗逆转录病毒疗法

基本信息

批准号：
10684940
负责人：
Tingting Zhang
金额：
$ 7.98万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10684940
关键词：
Acquired Immunodeficiency Syndrome Acute Address Adherence Admission activity Adult Age Years Aging Back Biometry Caring Cessation of life Characteristics Chronic Clinical Data Clinical Management Complex Coronary heart disease County Data Data Files Diabetes Mellitus Diagnosis Discipline of Nursing Disincentive Drops Drug Prescriptions Elderly Elements Epidemiologic Methods Evidence based intervention Fee-for-Service Plans Future Goals Grant HIV HIV therapy Health Services Research Health care facility Home Home Nursing Care Hospitalization Hospitals Hyperlipidemia Hypertension Individual Institution Intervention Knowledge Length of Stay Link Long-Term Care Longevity Medical Medicare Medicare claim Medication Errors Mental Health Methods Modeling Neighborhoods Nursing Homes Outcome Outpatients Patient Care Patients Pattern Persons Pharmaceutical Preparations Pharmacoepidemiology Polypharmacy Poverty Prevalence Process Provider Proxy Quality of Care Quality of life Recommendation Records Regimen Reporting Research Retrospective cohort study Risk Role Substance abuse problem Time United States Viral Viral Load result Work acute care aging population antiretroviral therapy cohort comorbidity demographics experience health management hospitalization rates improved mortality risk nursing home length of stay therapy adherence transmission process

项目摘要

Project Summary Background. The number of older people living with HIV (PLWH) in the U.S. is growing rapidly. Half of PLWH in 2016 were over 50 years of age, with an estimate of 70% by 2030. PLWH have high numbers of comorbidities, polypharmacy and high hospitalization rates. The transitions between care settings (e.g., home, hospital, post-acute care, and long-term care) that necessarily occur for PLWH who are aging – and the quality of care problems that these transitions create – are the focus of this proposal. Previous studies in the general aging population show that problems with medications are common after a hospitalization; approximately one fourth did not fill new prescriptions,14% experienced medication discrepancies and almost half were not adherent to medications following hospitalizations. There is limited data about medication-related quality problems following hospitalization for PLWH. In a recent study, only 64% of the study patients in the nursing homes (NHs) used ART. Our preliminary work with Medicare recipients has shown that about two thirds of a national cohort of NH residents with Part D (Medicare drug coverage) and HIV did not receive an ART during an average of 1 years of observation in NHs. The purposes of this proposed research are to (1) determine patterns of ART use in PLWH who made the care transition from outpatient status to NH care; and (2) identify patient level characteristics and nursing facility characteristics that are associated with the lack of ART use during NH stays following hospital discharge transitions. Methods. We propose to conduct a retrospective cohort study including all Medicare fee-for-service NH residents (2014-2018) nationally. First, we will identify PLWH who had an acute hospitalization that led to a NH admission. We will follow them to examine ART use during post-hospital discharge NH stays, and follow them backward in time to the prehospital period to determine whether they were on ART as outpatients. We will conduct multivariable models to determine correlates of non-ART use following the care transition. Covariates will include individual level characteristics, such as demographics, polypharmacy, comorbidity status, hospitalization length of stay and diagnosis; and nursing facility level characteristics such as HIV concentration, the availability of an AIDS unit and county level HIV prevalence as a proxy of provider HIV experience. Expected findings and future plans. We expect to observe that a reduction in ART use following the hospital discharge transition to NHs. ART use is a critical element of high-quality HIV care, and we are concerned that dropping of an ART regimen at NHs is a marker or indicator of broader quality of care problems. Our study will identify a clear focus for quality improvement interventions to ensure that PLWH in NHs (absent contraindications) are using ART. Our methods will also be used to conduct similar studies to ensure that other medications for chronic conditions are appropriately continued through complex care transitions.

项目摘要背景。美国艾滋病毒（PLWH）的老年人人数正在迅速增长。一半的PLWH 2016年超过50岁，到2030年估计为70％。合并症，多药和高住院率。护理环境之间的过渡（例如，家庭，医院，急性后护理和长期护理）必然发生老化的PLWH以及质量这些过渡会产生的护理问题 - 这是该提案的重点。先前的一般研究人口老龄化表明，住院后药物问题很常见。大约一个第四没有填写新处方，有14％的人经历了药物差异，几乎一半没有遵守住院后的药物。与药物相关质量的数据有限 PLWH住院后的问题。在最近的一项研究中，只有64％的研究患者房屋（NHS）使用艺术。我们与Medicare接收者的初步工作表明，大约三分之二的 NH居民的国家队列D（Medicare药物覆盖范围）和HIV在 NHS平均观察1年。这项拟议研究的目的是（1）确定 PLWH中的艺术使用模式，他从门诊状态过渡到NH护理；（2）识别与缺乏艺术相关的患者水平特征和护士设施特征在住院过渡后，在NH住院期间。方法。我们建议进行一项回顾性队列研究，包括所有医疗保险。居民（2014-2018）在全国范围内。首先，我们将确定有急性住院的PLWH导致NH 入场。我们将跟随他们检查院后出院期间的艺术使用NH住宿，然后跟随他们及时向后往返院前时期，以确定它们是否在艺术中为门诊病人。我们将进行多变量模型以确定护理过渡后非ART使用的相关性。协变量将包括个人级别特征，例如人口统计学，多药，合并症状态，住院时间和诊断长度；和护士设施水平的特征，例如HIV浓度，艾滋病部门和县级艾滋病毒流行率的可用性是提供者艾滋病毒经验的代表。预期的发现和未来计划。我们希望观察到医院后的艺术使用减少放电向NHS。艺术使用是高质量艾滋病毒护理的关键要素，我们担心在NHS上删除艺术方案是更广泛的护理问题的标志或指标。我们的研究愿意确定质量改进干预措施的明确重点，以确保NHS中的PLWH 禁忌症）正在使用艺术。我们的方法还将用于进行类似的研究，以确保其他通过复杂的护理过渡，适当地继续进行慢性病的药物。