Using Routinely Collected EHR Data to Optimize Patient Care, Refine Clinical Care Guidelines, And Inform Healthcare Policies for Vulnerable or Low-Resource HIV Patients

Abstract

University of Washington Abstract Using Routinely Collected EHR Data to Optimize Patient Care, Refine Clinical Care Guidelines, And Inform Healthcare Policies for Vulnerable or Low-Resource HIV Patients Canada Parrish Chair of the Supervisory Committee: Paul Fishman Department of Health Services Despite major achievements in HIV care over the last several decades, more effort is needed to improve service delivery to low-resource and vulnerable communities. Observational data from routine clinical sources represent a source of information for optimizing HIV care in settings where large, randomized trials are not feasible, or for populations typically excluded from clinical trials. This research used observational data from the centralized iSante EHR for Haitian HIV patients enrolled in care, as well as the CFAR Network of Integrated Clinical Systems (CNICS) electronic medical records-based network which integrates clinical data from HIV-infected persons in the United States. The specific aims included: defining the association between early linkage to care and various types of substance use; determining the causal effect of extending ART (antiretroviral therapy) prescription lengths on retention in care; assessing the potential subgroup differences in the effect of increasing ART prescription length and exploring refining existing ART guidelines. We found that those with substance use entered care earlier than those who did not report substance use, extending ART intervals causes an increase in retention in care; this effect does differ across patient subgroups, though a uniform ART guideline remains appropriate. This research provided insight into how to optimize care for key populations in efforts to reach national and global HIV care benchmarks.