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

Project Details - Ongoing

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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.

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