title: Integrating a web-based, patient-administered assessment into primary care for HIV-infected adults.
abstract: Providers routinely under diagnose at risk behaviors and outcomes, including depression, suicidal ideation, substance abuse, and poor medication adherence. To address this, we developed a web-based, self-administered patient-reported assessment tool and integrated it into routine primary care for HIV-infected adults. Printed results were delivered to providers and social workers immediately prior to patient appointments. The assessment included brief, validated instruments measuring clinically relevant domains including depression, substance use, medication adherence, and HIV transmission risk behaviors. Utilizing the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) approach to quality improvement, we addressed issues with clinic flow, technology, scheduling, and delivery of assessment results with the support of all levels of clinic staff. We found web-based patient-reported assessments to be a feasible tool that can be integrated into a busy multi-provider HIV primary care clinic. These assessments may improve provider recognition of key patient behaviors and outcomes. Critical factors for successful integration of such assessments into clinical care include: strong top-level /ort from clinic management, provider understanding of patient-reported assessments as a valuable clinical tool, tailoring the assessment to meet provider needs, communication among clinic staff to address flow issues, timeliness of delivery, and sound technological resources.
authors.affiliation: Center for AIDS Research, University of Washington, Box 359931, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: R
authors.initials: R
authors.lastname: Fredericksen
authors.affiliation: Center for AIDS Research, University of Washington, Box 359931, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Crane
authors.affiliation: Medical Education, University of Washington, Box 357240, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tufano
authors.affiliation: Center for Health Studies, School of Public Health, University of Washington, Box 358085, Seattle, WA, 98195, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ralston
authors.affiliation: Center for AIDS Research, University of Washington, Box 359931, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: S
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: Center for AIDS Research, University of Washington, Box 359931, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: T
authors.initials: T
authors.lastname: Brown
authors.affiliation: Center for AIDS Research, University of Washington, Box 359931, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: D
authors.initials: D
authors.lastname: Layman
authors.affiliation: Allergy and Infectious Disease, University of Washington, Box 359930, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Harrington
authors.affiliation: Allergy and Infectious Disease, University of Washington, Box 359930, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: S
authors.initials: S
authors.lastname: Dhanireddy
authors.affiliation: Allergy and Infectious Disease, University of Washington, Box 359930, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: T
authors.initials: T
authors.lastname: Stone
authors.affiliation: Biomedical and Health Informatics, University of Washington, 1959 NE Pacific, Seattle, WA, 98195, USA.
authors.forename: W
authors.initials: W
authors.lastname: Lober
authors.affiliation: Center for AIDS Research, University of Washington, Box 359931, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Kitahata
authors.affiliation: Center for AIDS Research, University of Washington, Box 359931, 325 9 Avenue, Seattle, WA, 98104, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Crane
keywords: HIV-infection; Patient-reported outcomes; patient-provider communication; plan-do-study-act (PDSA) cycle; quality improvement