An Internet-Based Information Technology to Reduce Medical Errors in Prescribing Anti-Retroviral Medications to HIV-Positive Patients (HIV TIPS)

HIV-related medical errors are a joint consequence of the complex and dynamic state of prescribing appropriate combinations of antiretroviral medications for Persons Living With HIV coupled with difficulties in disseminating current guidelines for treating HIV infection. Decisions must be made about when to begin anti-retroviral therapy, when to change a failing regimen, and what medication(s) to substitute. Adding to the complexity, medication regimens must be tailored to the individual patient: taking into consideration possible drug interactions; side-effect profile; previous medications taken; current health and immune-system status, including nutrition; viral load; length of time since infection, if known; and the likelihood of patient compliance given the expense of these drugs and the inconvenience of adhering to the dosing schedules. Inappropriate or inadequate treatment regimens have potentially adverse consequences not only for individual patients, but for public health as well, since it increases the chances that drug-resistant viral strains will develop.

Clinical Directors Network and Columbia University have been funded by U.S. Department of Health and Human Services, Health Resources & Services Administration to conduct a project to implement and evaluate an internet-based information technology aimed at reducing prescription errors and improving quality of care for HIV-positive patients in ambulatory care settings, designed to be used at point-of-care.

The interactive decision-support system, called HIV TIPS, offers online access to current national guidelines for administering anti-retroviral therapies to HIV+ adults and adolescents. It includes access to the text and tables of the guidelines through a web enabled user interface. Importantly, the software has programmed a set of interactive algorithms that will generate guidelines for medicating patients given specific patient parameters. It also includes a patient education module to assist clinicians in developing plans to help their patients adhere to prescribed medications.

Thirty-six Community/Migrant Health Centers will participate in the project. Eight of the 36 sites will be CDN-affliated Community Health Centers. Eligible sites must be providing medical care for at least 30 non-pregnant, HIV+ patients, have at least one computer with internet access available to clinicians, and make available patient charts for data collection.

Sites will be randomly assigned to one of three arms: Arm 1 offers an enhanced intervention that couples access to the website with push technology, Arm 2 offers access to the web-site system without a motivational component, and Arm 3 is a non-intervention control group. Providers in the control group will be offered access to the website technology following project data collection. Data on reduction in prescribing errors and improvement in client outcomes will be collected through chart abstraction. Use of the system will be documented through short clinician interviews and usage data collected from the website.

The proposed evaluation plan is designed to: (1) document the implementation of the IT intervention; (2) document provider use and satisfaction with the web-based clinical system; (3) assess the impact of the IT needs assessment component on improving acceptance of the web-based system; (4) assess the intervention and the needs assessment component on reduction in prescribing errors and improvement in client outcomes and (5) assess the cost-effectiveness of the web-based system and the addition of the IT needs assessment component.

Project Time Frame: October 1, 2002 – September 30, 2005

# of Participating Centers: Thirty-six (36)

Funding Sources: U.S. Department of Health and Human Services (1 H97 HA 00270-01)

PRINCIPAL INVESTIGATOR: Peter A. Messeri, Ph.D. Center for Applied Public Health Columbia University 722 West 168 th Street , 11 th Floor TEL: (212) 305-1549 FAX: (212) 305-3701 E-MAIL: pam9@columbia.edu	CO-PRINCIPAL INVESTIGATOR: Rita Kukafka, PhD Center for Applied Public Health Columbia University 722 West 168 th Street , 11 th Floor T EL: (212) 305-6821 FAX: (212) 305-3702 E-MAIL: rita.ukafka@dmi.columbia.edu	CO-INVESTIGATOR: Mari Millery, Ph.D. Center for Applied Public Health Columbia University 722 West 168 th Street , 11 th Floor TEL: (212) 305-6821 FAX: (212) 305-3702 E-MAIL: mm994@columbia.edu
CO-INVESTIGATOR: Jonathan N. Tobin, Ph.D. Clinical Directors Network, Inc. 5 West 37th Street , 10 th Floor New York , NY 10018 TEL: (212) 382-0699, ext. 234 FAX: (212) 382-0669 E-MAIL: jntobin@CDNetwork.org	PROJECT MANAGER:  Joaquin Aracena, MA Clinical Directors Network, Inc. 5 West 37th Street , 10 th Floor New York , NY 10018 TEL: (212) 382-0699, ext. 233 FAX: (212) 382-0669 E-MAIL: jarace@cdnetwork.org