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.

项目概要背景：美国艾滋病毒感染者 (PLWH) 的数量正在迅速增长，占 PLWH 的一半。 2016 年，感染者年龄超过 50 岁，预计到 2030 年，这一比例将达到 70%。合并症、多药治疗和高住院率。护理环境之间的转换（例如家庭、医院、急性期后护理和长期护理）对于老龄化的 PLWH 来说是必然发生的——以及质量这些转变造成的护理问题是本提案总体上的重点。人口老龄化表明，住院后药物问题很常见；第四名没有配新处方，14% 经历过药物差异，近一半没有经历过住院后坚持用药有关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% 的研究患者处于护理状态。我们对 Medicare 受益人的初步研究表明，大约三分之二的家庭 (NH) 使用了 ART。拥有 D 部分（医疗保险药物承保）和 HIV 的 NH 居民全国队列在治疗期间未接受 ART 在 NH 中进行平均 1 年的观察本拟议研究的目的是 (1) 确定从门诊护理转变为 NH 护理的 PLWH 的 ART 使用模式；(2) 确定与缺乏 ART 使用相关的患者水平特征和护理设施特征出院过渡后在 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 Medicare 按服务付费的 NH。全国居民（2014-2018 年）首先，我们将确定因急性住院而导致 NH 的 PLWH。我们将跟踪他们在出院后 NH 住院期间检查 ART 的使用情况，并跟踪他们。我们将及时回溯到院前阶段，以确定他们是否接受过 ART 治疗。建立多变量模型以确定护理过渡后非 ART 使用的相关性。将包括个人层面的特征，例如人口统计、多药治疗、合并症状况、住院时间和诊断；以及护理机构水平特征，例如艾滋病毒浓度、艾滋病单位的可用性和县级艾滋病毒流行率作为提供者艾滋病毒经验的代理。预期的结果和未来的计划我们期望观察到住院后 ART 的使用有所减少。出院后转用 ART 是高质量 HIV 护理的一个关键要素，我们担心的是 NH 放弃 ART 治疗方案是更广泛的护理质量问题的标志或指标。确定质量改进干预措施的明确重点，以确保 NH 中的 PLWH（缺乏禁忌症）正在使用 ART 我们的方法也将用于进行类似的研究，以确保其他。通过复杂的护理过渡，适当地继续治疗慢性病的药物。