Novel Uses of Data in HIV/AIDS - an Informatics Perspective Rita Kukafka, DrPH, MA Assistant Professor of Public Health and Biomedical Informatics Columbia University May 8, 2003 Washington, DC
Dec 25, 2015
Novel Uses of Data in HIV/AIDS
- an Informatics Perspective
Rita Kukafka, DrPH, MAAssistant Professor of Public Health and Biomedical InformaticsColumbia University
May 8, 2003Washington, DC
An Informatics Perspective on Data
Informatics methods makes possible novel uses of data
Collect Once, Use Many Examples from HIV TIPS - data collected
once is used to:– Evaluate selected patient/provider
outcomes– Tailor patient education– Promote IT system use
What is HIV TIPS ?
Web-based clinical support system designed to improve antiretroviral treatment effectiveness
Combines informatics methods and behavioral science theory
Primary Outcome: Reduce suboptimal prescribing practices
The Problem: Information Overload for Providers
Two million facts needed for practice– 10,000 diseases and syndromes– 3,000 medications– 1,100 laboratory tests– 400,000 articles added to biomedical literature each
year– Responsible for approximately 1,000,000 facts – Medical literature doubling every 19 years– Doubles every 22 months for AIDS care
Information Overload for Patients
Google Search – HIV/AIDS – 1,660,000 hits– HIV/AIDS treatment – 619,000 hits– HIV/AIDS patient education – 134,000
People tend to believe what they read Exploitation of patients is common on
the Internet Patients trust their doctors
Solution
Apply technology to provideThe right informationIn the right formTo the right personIn the right placeAt the right time
Tailored
Information
Provider
Services
HIV TIPS (Functional Modules)
Web-based Interactive Guidelines– interactive guidelines made available over
the web, at the point of care Patient-Tailored Print
Communications (TPC)– a computer tailored patient report
designed to assist physicians in carrying out the counseling recommendations according to the guidelines
Functions of the Interactive Guidelines
1. Present medications from which to select medication plan
2. Review proposed medication plan3. Compare medication plan against guidelines4. Present message related to inadequate
therapy, drug interactions, and side effects of proposed medication plan
5. Create education plan for selected medications
6. Print education plan for selected medications
Functions of the Patient Tailored Adherence Education
1. Collect patient data related to adherence2. Process patient data related to
adherence to provide tailored education about improving adherence
3. Provide printed tailored patient education about improving adherence
Level of Assessment
Generic communication
Tailored communication
Interpersonalcommunication
Not assessmentbased
Based on Assessment ofindividuals
Con
ten
t of
Com
mu
nic
ati
on
gen
eri
cin
div
idu
ali
zed
Patient-Tailored Education
Rationale for Tailoring:
Unessential information is eliminated
Information is more personally relevant, people pay more attention
When information attended to and processed, it is more effective than nontailored information in helping the person enact desired behavioral changes
Tailored communication elicits..
• greater attention• greater comprehension• greater likelihood of discussion of the
content with others• greater change in cognitive-behavioral
mediating constructs addressed by the content
• greater likelihood of behavior change
HIV TIPS Patient Education Tailoring Process
Determinant specification
Tailoring questionnaire
Constructmessages
Data fileMessage
file4.Write algorithms/5.Automate tailoring
process
Tailored communications
Step 1
Step 2 Step 3
Steps 4,5
Tailoring Variables
Barriers: addresses important barriers that HIV-positive patients experience
Side Effects: side effects to HIV-Medication to provide pointers on how to deal with side effects that particular patient is reporting
Self-efficacy: six dimensionsManage mood, manage medication, manage symptoms, communicate with healthcare provider, get support / help, manage fatigue
Medication review: provides adult dosing, possible side effect, notes and medicine image to the selected drug
System Architecture
HIV/AIDS Health care provider’s web browser
Web SeverCGIDB Driver
Internet
Service ProviderWeb browser
KnowledgeDatabase
nyc2000
******
HIV TIPS Innovative Approach
Designed for community providers without sophisticated technology
Maximize flexibility – 42 agencies with no uniformity of practice patterns
Use case scenarios used design navigation
Individual and agency level needs assessment to promote system use
30 – 70% IT projects fail – not adopted by end user
Agency Level Needs Assessment
Collect information on the technology resources, staff readiness, task flow, and barriers in IT use in the setting
Module developed to instruct AETCs on how to perform the assessment
A participatory design process to plan how the HIV Tips can be best used in the setting
If necessary, the clinic will be linked with appropriate resources to increase capacity
Provider Level Assessment
Collect provider-level data relevant for staging readiness to use the HIV TIPS software
Design provider-level tailored information and education material to motivate use
Use of push technology (email) to deliver provider tailored materials
Conceptual Diagram ofEnhanced Intervention
Usage Models(scenarios specifying roles for different users in a clinic)
Theory of Participatory Design
General Characteristics of Clinic (Capacity Survey, Observation Log, Attitude Survey)
Technology Inventory
Provider Attitudes (Staging Questionnaire)
Task Flow Assessment
Barriers Assessment
-Needs assessment data summarized in terms of barriers
Participatory Design Meeting (HIV TIPS Implementation Map)
Evaluation of Participatory Design Process:(Participant Survey, Design Process Description Tool)
Ongoing Support to Clinic
Computerized Matching of Staging with Tailored Messages
Tailored E-mail Messages to Providers
Ongoing Support to Users
Transtheoretical Model (Stages of Readiness)
GUIDING CONCEPTS
GUIDING CONCEPTS
ORGANIZATION LEVEL
INDIVIDUAL PROVIDER LEVEL
Evaluation of the HIV TIPS Intervention
Group Randomized Assignment of Clinics into 3 Treatment Conditions
• Enhanced IT Intervention• IT Intervention• No Intervention (control group)
Intervention Activities,for each Treatment Condition
Treatment Conditions →
Activities ↓
EnhancedIT
InterventionIT
Intervention
(control group)
No Intervention
IT Needs Assessment
access to HIV TIPS motivational and informational
Tailored Communications
Agency Recruitment
Agencies to be Recruited from large group participating in AETC longitudinal training initiatives.
12 Agencies from the Midwest AETC
30 Agencies from NY/NJ AETC
Study Selection Criteria
for Agencies/Clinics:– 25+ HIV-positive patients– Internet Access
for Patients:– Adult patients (non-pediatric,
not pregnant)– 2+ visits over past 12 months
(1 per 6-month period)– CD4 Counts < 500 or on
Medications
Provider-Level Variables of Interest
Exposure to Intervention:– Frequency with which HIV TIPS is accessed– Frequency that different components are used– Provider satisfaction with HIV TIPS
Patient-Level Variables of Interest
Descriptive/Demographic Information
– gender– age– race/ethnicity– housing status– insurance coverage– substance abuse/mental health
Current Health Status– CD4-cell count– HIV viral load– current opportunistic infections– current adverse drug reactions
Current Anti-Retroviral Regimen
– drugs prescribed– Dosage– dosing schedule– any change in medications
Medication History– previous anti-retrovirals taken– previous adverse drug reactions– viral resistance testing, if available– other medications that have known
HIV/AIDS-drug interactions
Sources of Evaluation Data
Treatment Conditions →
Data Sources ↓
EnhancedIT
Intervention
IT Interventi
on
No Intervent
ionclinic & training information from
AETC Information Forms
frequency and extent of IT use
from Website Usage Data
satisfaction with IT gauged in
Provider Surveys
Changes in provider readiness (barriers to
system use)
Changes in patient variables associated with
adherence
client demographics, health status, & medications from
Chart Review
Stored data- used to tailor messages Stored data – used to tailor messagesextended design
Summary
Examples from HIV TIPS – collect once, use many – tailoring patient education– tailoring provider to increase system usage– evaluation
Informatics methods (e.g., data storage, retrieval, sharing) makes optimal the use of biomedical information, data, and knowledge
As illustrated by HIV TIPS can be used for problem solving and decision making in addition to evaluation