Implementation and Evaluation of psPRO: Person-Specific Patient-Reported Outcome Assessments for Patients in HIV Care Living with Multiple Chronic Conditions (Washington)

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Tailoring Visits Using Person-Specific Patient-Reported Outcomes to Improve Care for People with HIV

SIGNIFICANCE AND POTENTIAL IMPACT

By identifying and addressing PROs that matter most to patients, this research has the potential to maximize clinic time spent with patients with HIV and chronic conditions to tailor and improve their care.

Patients with HIV are living longer, and with additional chronic conditions

People with HIV are living much longer due to antiretroviral treatments; however, this increasingly aging population has a large burden of multiple chronic conditions that may impact functioning, symptom burden, and outcomes. Clinicians providing HIV care must prioritize and address multiple chronic conditions in the context of a time-constrained clinic visit. In addition, those with HIV may not have the opportunity to voice their needs, given the many pressures on short clinical encounters and provider preconceptions that sometimes steer the direction of the conversation. Recent work by co-principal investigators Drs. Heidi Crane and William Lober at the University of Washington found that using a brief, tablet-based, clinical assessment that captured PROs improved identification of conditions such as substance misuse and depression.

These PRO assessments, completed by patients at the beginning of clinic visits, can help providers focus visit discussions on the patient’s most relevant needs. However, current PRO assessment lacks provider input regarding the most clinically relevant priorities for treating patients with multiple chronic conditions. PRO assessment and prioritization must be streamlined to minimize impact on clinic flow and maximize relevance to providers and patients. For example, Dr. Crane noted, “It doesn’t make sense to ask all people with HIV if they have Narcan (naloxone) at home to prevent overdoses, but for the very small number of people that are heroin users it’s incredibly important.”

Examining person-specific PRO use in clinical practice

To address this, Dr. Crane, Dr. Lober, and their research team wanted to improve methods for systematic collection and use of PROs in clinical care for people with HIV with multiple chronic conditions using person-specific PRO (psPRO) prioritization. Interviews with HIV care providers and patients will identify clinical priorities for people with HIV and inform the development of algorithms to prioritize PROs that reflect the conditions, priorities, and values identified. They will then implement real-time psPRO collection for people with HIV into routine clinical care. The team will conduct a randomized trial with the Centers for AIDS Research Network of Integrated Clinical Systems, a consortium of eight sites providing care for over 30,000 people with HIV, to evaluate the effectiveness of personalized PROs in improving care.

“We're never going to be able to expand the amount of time in a visit and the amount of questions we can ask. There is a limit to what you can embed in clinic flow. Using psPROs to continually get better and better at targeting the items for patients will have an impact on their health outcomes.”
- Dr. Crane

The team hopes that this work will help customize and improve care for people with HIV and multiple chronic conditions. This work will help providers identify priority issues relevant to their patients and maximize clinic time to address these issues.

“This can help providers take better care of patients and do it more efficiently. The information provided by patients can help providers target their efforts on areas where their interventions can have the greatest impact.”
- Dr. Lober
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By identifying and addressing PROs that matter most to patients, this research has the potential to maximize clinic time spent with patients with HIV and chronic conditions to tailor and improve their care.

Project Details - Ongoing

Summary:

People with HIV are living much longer due to antiretroviral treatments; however, this increasingly aging population has a large burden of multiple chronic conditions that may impact functioning, symptom burden, and risk behaviors. HIV providers must prioritize and address multiple chronic conditions in the context of a time-constrained clinic visit.

Recent work by the investigators found that computerized, tablet-based, self-administered patient-reported measures and outcomes (PROs) significantly improved detection of conditions such as substance abuse and depression. These PROs, completed by patients at the beginning of clinic visits and made immediately available to clinicians, proved valuable to providers for structuring discussions of clinical problems. However, to date, the investigators have been limited to using an approach to PRO assessment that lacks provider input regarding the most clinically relevant priorities for treating patients with multiple chronic conditions. PRO assessment and prioritization must be streamlined to minimize impact on clinic flow and maximize relevance to providers and patients.

In this current research, the investigators are applying innovative health information technology (IT) strategies to improve methods for systematic collection and use of PROs in clinical care for those with multiple chronic conditions using person-specific PRO (psPRO) domain prioritization.

The specific aims of the research are as follows:

  1. Develop strategies for psPRO collection according to clinical priorities for treating patients with multiple chronic conditions by personalizing PRO domain selection in real time. 
  2. Implement real-time automatic psPRO collection for people with HIV with multiple chronic conditions. 
  3. Evaluate effectiveness of integrating psPROs for people with HIV with multiple chronic conditions as an innovative health IT strategy for improving clinical care. 

Interviews with HIV care providers and people with HIV will identify the key chronic conditions and clinical priorities for people with HIV and inform the development of algorithms to prioritize PROs that reflect the conditions, priorities, and values identified. They will then implement real-time psPRO collection for people with HIV and chronic conditions into routine clinical care at Centers for AIDS Research Network of Integrated Clinical Systems sites, which is a consortium of eight sites providing care for over 30,000 people with HIV. The team will conduct a randomized trial to evaluate the effectiveness of integrating personalized PROs in improving care. They will compare clinical documentation and actions, for example prescriptions and referrals by providers for chronic condition-related issues, of those randomized to standard PRO feedback versus psPRO feedback.