Patient-Reported Outcomes Measurement Information System -- Phase II: HIV Clinical Outcomes

This project's goal is to improve health care processes and outcomes for patients infected with HIV in clinical practice settings using routine collection of patient-reported outcomes (PROs) administered by computerized adaptive tests (CATs). The research team is integrating PROMIS data with other clinical and administrative data captured during clinical care to deliver useful and actionable information to the provider at the point of care in real-time. The team is evaluating PROs in a nationally distributed consortium of HIV clinics associated with the Centers for AIDS Research (CFAR) Network of Integrated Cohort Studies (CNICS). PRO data are being collected at 8 clinical sites that provide care for a cohort of >20,000 HIV-infected individuals.

We will accomplish these goals by pursuing three specific aims:

• AIM 1: Develop and assess five existing and two new PROMIS domains using short forms and hybrid CATs based on qualitative content validity interviews and focus groups involving English- and Spanish-speaking patients with HIV and state-of-the-art modern test theory quantitative methods. Existing and new domains are being selected by providers, researchers, and HIV-infected patients. The team, involving providers and researchers from the clinical sites, is collaborating using qualitative and quantitative mixed methods to modify standard CAT algorithms to ensure that items patients and providers deem important are administered. PROMIS items are being evaluated for differential item functioning (DIF) and individual- and group-level DIF impact.
• AIM 2: Determine the effect on care processes and patient outcomes of integrating routine PROMIS CAT PRO data with individually tailored treatment recommendations using the Chronic Care Model, a comprehensive health improvement approach, in eight HIV clinics. The team will engage in well-established quality improvement initiatives involving all stakeholders to overcome any existing barriers to routine PRO collection in clinical care. PROs will be collected from patients during visits to their clinicians and results will be delivered to providers with recommendations specific to that patient's PRO results for use in the immediate and subsequent clinical encounters. For one PROMIS domain, the team will use a randomized controlled trial design to evaluate the effectiveness of PRO integration into clinical care in changing process outcomes, clinical outcomes, PROs, and patient satisfaction with care.
• AIM 3: Collaborate with the PROMIS II Network to add value to the PROMIS initiative. The team will contribute to the PROMIS network patient data and software tools, and will develop and evaluate techniques to analyze DIF in data collected by CATs. Dr. Patrick is chairing the PROMIS II publications committee, Dr. Paul Crane is chairing the PROMIS II clinical practice committee, and Dr. Heidi Crane is serving on multiple committees. Project investigators are participating in qualitative and quantitative methods development as well as the use of PROMIS measures in the Latino population.

PUBLIC HEALTH RELEVANCE: This project will evaluate the validity of PROMIS domains in patients infected with HIV, making PROMIS applicable to this large, underserved population. The project addresses critical limitations of prior research integrating PRO data into routine clinical care. If successful, this project may influence the shape and content of routine clinical care for patients with HIV in the United States.

For more information about the PROMIS network, go to http://www.nihpromis.org.