Evaluating the Concordance of Clinician Antiretroviral Prescribing Practices and HIV-ASSIST, an Online Clinical Decision Support Tool

Jesus A. Ramirez, Manoj V. Maddali, Jehan Z. Budak, Jonathan Z. Li, Harry Lampiris, Maunank Shah

Research output: Contribution to journalArticle

Abstract

Background: Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to rank ARV combinations based upon a composite objective of achieving viral suppression and maximizing tolerability. Objective: To evaluate concordance of HIV-ASSIST recommendations with ARV selections of experienced HIV clinicians. Design: Retrospective cohort study. Patients: New and established patients at the Johns Hopkins Bartlett HIV Clinic and San Francisco Veterans Affairs HIV Clinic completing clinic visits were included. Chart reviews were conducted of the most recent clinic visit to generate HIV-ASSIST recommendations, which were compared to prescribed regimens. Main Measures: For each provider-prescribed regimen, we assessed its corresponding HIV-ASSIST “weighted score” (scale of 0 to 10 +, scores of < 2.0 are preferred), rank within HIV-ASSIST’s ordered listing of ARV regimens, and concordance with the top five HIV-ASSIST ranked outputs. Key Results: Among 106 patients (16% female), 23 (22%) were ARV-naïve. HIV-ASSIST outputs for ARV-naïve patients were 100% concordant with prescribed regimens (median rank 1 [IQR 1–3], median weighted score 1.1 [IQR 1–1.2]). For 18 (17%) ARV-experienced patients with ongoing viremia, HIV-ASSIST outputs were 89% concordant with prescribed regimens (median rank 2 [IQR 1–3], median weighted score 1 [IQR 1–1.2]). For 65 (61.3%) patients that were suppressed on a current ARV regimen, HIV-ASSIST recommendations were concordant 88% of the time (median rank 1 [IQR 1–1], median weighted score 1.1 [IQR 1–1.6]). In 18% of cases, HIV-ASSIST weighted score suggested that the prescribed regimen would be considered “less preferred” (score > 2.0) than other available alternatives. Conclusion: HIV-ASSIST is an educational decision support tool that provides ARV recommendations concordant with experienced HIV providers from two major academic centers for a diverse set of patient scenarios.

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Clinical Decision Support Systems
HIV
Ambulatory Care
San Francisco
Veterans
Drug Interactions
Drug Resistance
Comorbidity
Cohort Studies
Retrospective Studies
Viruses
Pharmaceutical Preparations

Keywords

  • clinical
  • HIV
  • MCDA
  • prescribing
  • tool

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Evaluating the Concordance of Clinician Antiretroviral Prescribing Practices and HIV-ASSIST, an Online Clinical Decision Support Tool. / Ramirez, Jesus A.; Maddali, Manoj V.; Budak, Jehan Z.; Li, Jonathan Z.; Lampiris, Harry; Shah, Maunank.

In: Journal of general internal medicine, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Evaluating the Concordance of Clinician Antiretroviral Prescribing Practices and HIV-ASSIST, an Online Clinical Decision Support Tool",
abstract = "Background: Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to rank ARV combinations based upon a composite objective of achieving viral suppression and maximizing tolerability. Objective: To evaluate concordance of HIV-ASSIST recommendations with ARV selections of experienced HIV clinicians. Design: Retrospective cohort study. Patients: New and established patients at the Johns Hopkins Bartlett HIV Clinic and San Francisco Veterans Affairs HIV Clinic completing clinic visits were included. Chart reviews were conducted of the most recent clinic visit to generate HIV-ASSIST recommendations, which were compared to prescribed regimens. Main Measures: For each provider-prescribed regimen, we assessed its corresponding HIV-ASSIST “weighted score” (scale of 0 to 10 +, scores of < 2.0 are preferred), rank within HIV-ASSIST’s ordered listing of ARV regimens, and concordance with the top five HIV-ASSIST ranked outputs. Key Results: Among 106 patients (16{\%} female), 23 (22{\%}) were ARV-na{\"i}ve. HIV-ASSIST outputs for ARV-na{\"i}ve patients were 100{\%} concordant with prescribed regimens (median rank 1 [IQR 1–3], median weighted score 1.1 [IQR 1–1.2]). For 18 (17{\%}) ARV-experienced patients with ongoing viremia, HIV-ASSIST outputs were 89{\%} concordant with prescribed regimens (median rank 2 [IQR 1–3], median weighted score 1 [IQR 1–1.2]). For 65 (61.3{\%}) patients that were suppressed on a current ARV regimen, HIV-ASSIST recommendations were concordant 88{\%} of the time (median rank 1 [IQR 1–1], median weighted score 1.1 [IQR 1–1.6]). In 18{\%} of cases, HIV-ASSIST weighted score suggested that the prescribed regimen would be considered “less preferred” (score > 2.0) than other available alternatives. Conclusion: HIV-ASSIST is an educational decision support tool that provides ARV recommendations concordant with experienced HIV providers from two major academic centers for a diverse set of patient scenarios.",
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T1 - Evaluating the Concordance of Clinician Antiretroviral Prescribing Practices and HIV-ASSIST, an Online Clinical Decision Support Tool

AU - Ramirez, Jesus A.

AU - Maddali, Manoj V.

AU - Budak, Jehan Z.

AU - Li, Jonathan Z.

AU - Lampiris, Harry

AU - Shah, Maunank

PY - 2019/1/1

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N2 - Background: Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to rank ARV combinations based upon a composite objective of achieving viral suppression and maximizing tolerability. Objective: To evaluate concordance of HIV-ASSIST recommendations with ARV selections of experienced HIV clinicians. Design: Retrospective cohort study. Patients: New and established patients at the Johns Hopkins Bartlett HIV Clinic and San Francisco Veterans Affairs HIV Clinic completing clinic visits were included. Chart reviews were conducted of the most recent clinic visit to generate HIV-ASSIST recommendations, which were compared to prescribed regimens. Main Measures: For each provider-prescribed regimen, we assessed its corresponding HIV-ASSIST “weighted score” (scale of 0 to 10 +, scores of < 2.0 are preferred), rank within HIV-ASSIST’s ordered listing of ARV regimens, and concordance with the top five HIV-ASSIST ranked outputs. Key Results: Among 106 patients (16% female), 23 (22%) were ARV-naïve. HIV-ASSIST outputs for ARV-naïve patients were 100% concordant with prescribed regimens (median rank 1 [IQR 1–3], median weighted score 1.1 [IQR 1–1.2]). For 18 (17%) ARV-experienced patients with ongoing viremia, HIV-ASSIST outputs were 89% concordant with prescribed regimens (median rank 2 [IQR 1–3], median weighted score 1 [IQR 1–1.2]). For 65 (61.3%) patients that were suppressed on a current ARV regimen, HIV-ASSIST recommendations were concordant 88% of the time (median rank 1 [IQR 1–1], median weighted score 1.1 [IQR 1–1.6]). In 18% of cases, HIV-ASSIST weighted score suggested that the prescribed regimen would be considered “less preferred” (score > 2.0) than other available alternatives. Conclusion: HIV-ASSIST is an educational decision support tool that provides ARV recommendations concordant with experienced HIV providers from two major academic centers for a diverse set of patient scenarios.

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