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CDA 14-156 – HSR&D Study

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CDA 14-156
A Patient-centered Approach to Comorbidity Management in Aging Veterans with HIV
Gemmae M Fix PhD MA BS
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: May 2016 - April 2021

BACKGROUND/RATIONALE:
As a leader in healthcare, the Department of Veteran Affairs (VA) is transforming to a patient-centered model where care is personalized, proactive and patient-driven; health and wellbeing are situated within patients' life contexts. Complex patients, such as those with HIV, may benefit in particular from this transformation to a patient-centered model of care. HIV is now a chronic condition; Veterans with HIV are living longer. Consequently, comorbidities are often of greater importance to their overall health than HIV status alone and a major concern of providers. Further complicating disease management, patients with HIV have less education, high unemployment, and are more likely to live in poverty or experience homelessness. Yet, HIV providers may not be attuned to patient life contexts and, as specialists, may not be comfortable managing comorbidities. Patient-centered management of HIV necessitates providers ask about patients' life context, learn about their daily activities and priorities, and then tailor care plans accordingly.

OBJECTIVE(S):
1) Understand how Veterans with HIV engage in health behaviors in the context of their daily lives. 2) Explore how HIV providers consider the role of patient context and comorbidities when providing care. 3) Examine communication between HIV providers and their aging patients to understand how they attend to context and comorbidities.

METHODS:
The objectives will be accomplished through three projects. Project 1 will be an ethnographic exploration of patients' illnesses experiences situated in their daily-lives and contexts. Patients with HIV will be interviewed and observed as they go about daily activities. Project 2 will examine how HIV providers attend to and incorporate patient contexts and comorbidities when providing care. General HIV clinic functioning will be observed and providers will be interviewed. Project 3 will examine how providers attend to and incorporate context in clinical interactions with patients with HIV. Patient-provider clinical encounters will be recorded and analyzed, to identify elements of comorbidity management, attention to context and shared-decision making.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
N/A

PUBLICATIONS:

Journal Articles

  1. Fix GM, Hyde JK, Bolton RE, Parker VA, Dvorin K, Wu J, Skolnik AA, McInnes DK, Midboe AM, Asch SM, Gifford AL, Bokhour BG. The moral discourse of HIV providers within their organizational context: An ethnographic case study. Patient education and counseling. 2018 Dec 1; 101(12):2226-2232.
  2. Hill JN, Locatelli SM, Bokhour BG, Fix GM, Solomon J, Mueller N, LaVela SL. Evaluating broad-scale system change using the Consolidated Framework for Implementation Research: challenges and strategies to overcome them. BMC research notes. 2018 Aug 4; 11(1):560.
  3. Bokhour BG, Fix GM, Mueller NM, Barker AM, Lavela SL, Hill JN, Solomon JL, Lukas CV. How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC health services research. 2018 Mar 7; 18(1):168.
  4. Bolton RE, Fix GM, VanDeusen Lukas C, Elwy AR, Bokhour BG. Biopsychosocial benefits of movement-based complementary and integrative health therapies for patients with chronic conditions. Chronic Illness. 2018 Jan 1; 1742395318782377.
  5. Shimada SL, Petrakis BA, Rothendler JA, Zirkle M, Zhao S, Feng H, Fix GM, Ozkaynak M, Martin T, Johnson SA, Tulu B, Gordon HS, Simon SR, Woods SS. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging. Journal of the American Medical Informatics Association : JAMIA. 2017 Sep 1; 24(5):942-949.
  6. Fix GM, VanDeusen Lukas C, Bolton RE, Hill JN, Mueller N, LaVela SL, Bokhour BG. Patient-centred care is a way of doing things: How healthcare employees conceptualize patient-centred care. Health expectations : an international journal of public participation in health care and health policy. 2018 Feb 1; 21(1):300-307.
Journal Other

  1. Fix GM, Bolton RE, Bokhour BG. Challenges in Implementing Personalized Care Planning. JAMA. 2017 Nov 7; 318(17):1713.
Conference Presentations

  1. Luger T, Bokhour BG, Bolton RE, Ruben M, Hogan TP, Solomon J, Barker A, Fix GM. Continuing the Conversation: Ongoing Follow-up of Personalized Health Plan. Presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Mar 30; Washington, DC.


DRA: Aging, Older Veterans' Health and Care, Infectious Diseases
DRE: Prognosis
Keywords: Care Coordination
MeSH Terms: none