Prediktiv analyse og klinisk beslutningsstøtte for å forbedre forskrivning av prep (PrEDICT)
Prediktiv analyse og klinisk beslutningsstøtte for å forbedre forskrivning i fellesskap i samfunnshelsesentre
Scale-up of HIV preexposure prophylaxis (PrEP) is a key strategy of the U.S. initiative to end the HIV epidemic, but healthcare providers lack tools to support PrEP discussions and prescribing for patients likely to benefit. This research will evaluate whether integrating automated tools into electronic health records to help providers efficiently and equitably identify potential candidates for PrEP, discuss PrEP, and prescribe PrEP can improve PrEP initiation and persistence in safety-net community health centers. It will achieve this by conducting a stepped-wedge trial of a decision support tool with an embedded HIV prediction model to identify patients likely to benefit from PrEP. The intervention will be delivered to healthcare providers in 16 community health centers within the national OCHIN network.
Studieoversikt
Status
Status
Forhold
Forhold
Intervensjon / Behandling
Intervensjon / Behandling
Studietype
Studietype
Registrering (Antatt)
Registrering
Fase
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
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California
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Fremont, California, Forente stater, 94538
- Bay Area Community Health Liberty Clinic
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Oakland, California, Forente stater, 94605
- Lifelong East Oakland Health Center
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Oceanside, California, Forente stater, 92054
- TrueCare Oceanside Family Medicine
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Palm Springs, California, Forente stater, 92262
- DAP Legacy
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Sacramento, California, Forente stater, 95811
- One Community Health Midtown Campus
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Connecticut
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Bridgeport, Connecticut, Forente stater, 06605
- Southwest Community Health Center 968 Fairfield Avenue
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Georgia
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Atlanta, Georgia, Forente stater, 30312
- Mercy Care Decatur Street
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Iowa
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Sioux City, Iowa, Forente stater, 51105
- Siouxland Community Health Center Sioux City
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Massachusetts
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Lynn, Massachusetts, Forente stater, 01901
- Lynn Community Health Center 269 Union
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Mattapan, Massachusetts, Forente stater, 02126
- Mattapan Community Health Center Blue Hill
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Ohio
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Cleveland, Ohio, Forente stater, 44102
- Neighborhood Family Practice Ridge Community Health Center
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Painesville, Ohio, Forente stater, 44077
- Signature Health Painesville
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Oklahoma
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Oklahoma City, Oklahoma, Forente stater, 73112
- Variety Care Sequoyah
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Oregon
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Portland, Oregon, Forente stater, 97214
- Prism Belmont
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Texas
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Houston, Texas, Forente stater, 77031
- Bee Busy Wellness Center Bray Oaks
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Washington
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Seattle, Washington, Forente stater, 98122
- Seattle Roots Community Health Carolyn Downs Community Clinic
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Deltakelseskriterier
Kvalifikasjonskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Delivery site saw at least 500 distinct patients in 2024 during in-person or telehealth visits
- Delivery site had at least 10 new HIV diagnoses or positive HIV screening tests in 2023
- Delivery site provides primary care other than pediatrics, and the primary care department(s) were active on OCHIN Epic as of 1/1/2023
Exclusion Criteria:
- Delivery site specializing in HIV or STI care
- Correctional facilities
- Mobile sites
- School-based health center sites
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Forebygging
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Antall våpen
Våpen og intervensjoner
Deltakergruppe / ArmDeltakergruppe / Arm |
Intervensjon / BehandlingIntervensjon / Behandling |
|---|---|
|
Ingen inngripen: Standard of Care
Data will be extracted from EHRs of control clinics as a comparison, and those clinics will not actively participate in study activities |
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Aktiv komparator: Predictive analytics and clinical decision support
Providers in enrolled intervention clinics will receive point-of-care notifications via the EHR-embedded decision support tool about patients who are at increased predicted HIV risk and therefore likely to benefit from PrEP |
The intervention will include automated EHR notifications to clinicians at 16 OCHIN community health centers about patients who are likely to benefit from PrEP. These patients will be identified by an HIV prediction model that was developed and validated during the pilot phase of this study using historical OCHIN EHR data. For patients above a preselected threshold of predicted HIV risk, clinicians will be notified at the point of care that the patient may benefit from PrEP and will be provided with EHR-based tools to support discussions and prescribing. The intervention will also include coaching on PrEP and the decision support tool, as well as project team support during the trial period. |
Hva måler studien?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
PrEP initation
Tidsramme: 30 months
|
Proportion of patients above the prediction model risk threshold without a recently active PrEP prescription (within the prior 6 months) or prior HIV diagnosis who are prescribed PrEP during the study period. |
30 months
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
PrEP persistence
Tidsramme: 30 months
|
Proportion of patients prescribed PrEP who persist on PrEP for 6 and 12 months, as measured by prescription refills ordered. |
30 months
|
Samarbeidspartnere og etterforskere
Sponsor
Sponsor
Samarbeidspartnere
Samarbeidspartnere
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Studiestart
Primær fullføring (Antatt)
Primær fullføring
Studiet fullført (Antatt)
Studiet fullført
Datoer for studieregistrering
Først innsendt
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Først lagt ut
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Sist oppdatering lagt ut
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Andre studie-ID-numre
Andre studie-ID-numre
- PH001008
- R01MH133515 (U.S. NIH-stipend/kontrakt)
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
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