Risk factors for chronic obstructive pulmonary disease exacerbations, quality of care, and outcomes in people with HIV

HIV 感染者慢性阻塞性肺病恶化的危险因素、护理质量和结果

基本信息

批准号：
10700228
负责人：
Ioannis Konstantinidis
金额：
$ 16.31万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10700228
关键词：
Acceleration Accounting Acute Adherence Adult Adverse effects Affect Age Ambulatory Care CD4 Lymphocyte Count Caring Cause of Death Characteristics Chronic Chronic Care Chronic Obstructive Pulmonary Disease Clinical Data Clinical Practice Guideline Cohort Studies Communication Continuity of Patient Care Critical Care Data Data Analyses Data Mart Data Science Data Set Development Plans Disease Outcome Disease Progression Effectiveness Electronic Health Record Environment Epidemiology Event Evidence based practice Female Foundations Future General Population Goals Guideline Adherence Guidelines HIV HIV Infections Health Insurance Health Services Health system Hospitalization Hypersensitivity Immunologic Deficiency Syndromes Incidence Individual Influenza vaccination Institution International Intervention Knowledge Leadership Linear Models Link Logistic Regressions Lung Medicine Mentors Mentorship Methodology Minority Modeling Morbidity - disease rate Outcome Patient-Focused Outcomes Patients Pattern Persons Pharmacotherapy Population Positioning Attribute Practice Guidelines Predisposition Prevention Guidelines Probability Process Provider Public Health Public Health Informatics Quality of Care Quality of life Random Allocation Recommendation Research Research Activity Research Personnel Resources Retrospective cohort study Risk Risk Factors Sample Size Sampling Severities Site Smoking Socioeconomic Status Spirometry Statistical Models Symptoms System Testing Training Training Activity Universities Viral Load result Viremia Work career development case control causal model comorbidity comparative effectiveness compliance behavior cost data integration demographics experience health data hospital readmission improved improved outcome innovation inpatient service low socioeconomic status member modifiable risk mortality process improvement pulmonary rehabilitation sex skills smoking cessation

项目摘要

PROJECT SUMMARY AND ABSTRACT Chronic obstructive pulmonary disease (COPD) is an important public health problem in people with HIV (PWH). PWH have 3-fold the odds of COPD as uninfected people after adjusting for smoking. Acute exacerbations of COPD (AECOPD) are the principal contributor to COPD morbidity and mortality. Given the adverse effects of AECOPD, international practice guidelines for the prevention and management of AECOPD exist in the general population. Limited evidence suggests that HIV infection is associated with increased risk for AECOPD, but data on the effect of HIV infection on post-AECOPD outcomes are lacking. We also lack data on quality of COPD care or the relationship between processes of care and outcomes in PWH. Scientific aims of this K08 are to determine: 1) risk factors for AECOPD in PWH and uninfected people; 2) the effect of HIV infection on outcomes after AECOPD; 3) the effect of HIV infection on COPD treatment concordance with guidelines and the relation- ship between COPD care quality and outcomes in PWH. Hypotheses: 1) HIV infection, “traditional” AECOPD risk factors, and HIV-specific factors are associated with AECOPD with interaction effects between age, smoking, and poorly controlled HIV infection that enhance susceptibility to AECOPD; 2) HIV infection is associated with increased readmissions and mortality after AECOPD; 3) guideline-concordant tests and therapies are underpre- scribed in PWH compared to uninfected people and high-quality COPD care is associated with improved out- comes in PWH. We will test our hypotheses in a cohort study of HIV-infected and uninfected controls with ad- ministrative and electronic health record (EHR) data from health systems across the US in a causal inference framework using nested case-control sampling to randomly select controls and inverse probability treatment weighting for analysis, thus emulating a target trial with HIV infection as “treatment.” Data from this study will lay the groundwork for the candidate’s future R01 proposals to assess patient adherence to COPD therapies and to test interventions to optimize COPD care at the patient, provider, and system level. Through an integrated train- ing plan of intensive mentorship, didactic coursework, experiential research, and academic activities, the candi- date will accomplish his career development goals to develop expertise in: 1) health informatics and data science for analysis of administrative and EHR data; 2) hierarchical and longitudinal statistical modeling; 3) causal infer- ence from observational data; and 4) leadership, communication, and knowledge dissemination skills. The re- sources and experiences of the candidate’s mentors (Drs. Alison Morris, Katie Suda, and Scott Rothenberger), supportive research environment at the University of Pittsburgh, and strong institutional commitment from the Division of Pulmonary, Allergy, and Critical Care Medicine assure the successful execution of the proposed research and training activities and the candidate’s transition into an independent comparative effectiveness and health services investigator developing effective management strategies for high-quality COPD care in PWH.

项目摘要和摘要慢性阻塞性肺疾病（COPD）是艾滋病毒（PWH）患者的重要公共卫生问题。调整吸烟后，PWH作为未感染的人的COPD几率。急性加重 COPD（AECOPD）是COPD发病率和死亡率的主要贡献者。考虑到 AECOPD，国际预防和管理AECOPD的国际实践指南人口。有限的证据表明，艾滋病毒感染与AECOPD的风险增加有关，但数据缺乏关于艾滋病毒感染对艾科后结果的影响。我们也缺乏有关COPD质量的数据护理或PWH中的护理过程与结果之间的关系。该K08的科学目的是确定：1）AECOPD在PWH和未感染的人中的风险因素； 2）HIV感染对结局的影响 Aecopd之后； 3）HIV感染对COPD治疗一致性与指南和关系的影响 - 在PWH中的COPD护理质量和结果之间发货。假设：1）HIV感染，“传统” AECOPD 危险因素和HIV特异性因素与AECOPD有关，与年龄，吸烟，以及无法控制的HIV感染，增强了对AECOPD的敏感性； 2）HIV感染与 AECOPD后的再入院和死亡率增加； 3）指南符合测试和疗法的不足与未感染的人相比，用PWH的脚本和高质量的COPD护理与改善相关 - 出现在PWH中。我们将在对HIV感染和未感染的对照组的队列研究中检验我们的假设来自美国卫生系统的事务所和电子健康记录（EHR）数据使用嵌套的病例对照采样的框架来随机选择控件和逆概率处理进行分析的权重，从而模仿HIV感染作为“治疗”的目标试验。这项研究的数据将是候选人未来R01提案的基础，以评估患者对COPD疗法的遵守和测试干预措施以优化患者，提供商和系统级别的COPD护理。通过综合火车 - 综合思想，教学课程，专家研究和学术活动的计划日期将实现他的职业发展目标，以发展专业知识：1）健康信息和数据科学用于分析行政和EHR数据； 2）分层和纵向统计建模； 3）因果下降 - 从观察数据中获得； 4）领导，沟通和知识传播技巧。那里- 候选人导师的资料和经验（艾莉森·莫里斯（Alison Morris）博士，凯蒂·苏达（Katie Suda）和斯科特·罗滕伯格（Scott Rothenberger）），匹兹堡大学的支持性研究环境，以及来自肺部，过敏和重症监护医学司确保成功执行拟议的研究和培训活动以及候选人过渡到独立的比较有效性和卫生服务调查员制定了PWH中高质量COPD护理的有效管理策略。