Enhancing Communication and HIV Outcomes The ECHO Study

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Enhancing Communication and HIV Outcomes--- The
ECHO Study ---

• Mary Catherine Beach, MD, MPH
• Johns Hopkins University
• Ryan White Care Act Annual Meeting
• Washington, DC
• August 30, 2006

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Enhancing Communication and HIV Outcomes (ECHO)

• Initiative from HRSA to
• Phase 1 Measure patient-provider communication
  in HIV care, and assess impact of communication
  on HIV outcomes
• Phase 2 Design an intervention to enhance
  communication (patient and/or provider)
• Phase 3 Reassess communication and outcomes
• Special interest in racial differences in
  communication and outcomes (funded by Minority
  AIDS Initiative)

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Enhancing Communication and HIV Outcomes (ECHO)

• Study nested within HIV Research Network
• A national network of academic and
  community-based adult and pediatric HIV care
  sites established in 2000 to assess clinical and
  health resource utilization outcomes in HIV
  infection
• Settings
• Evaluation and Technical Assistance Center (ETAC)
• Johns Hopkins University
• Data Collection at 4 sites in the HIV Research
  Network
• Johns Hopkins University
• Oregon Health Sciences University
• St. Lukes/ Roosevelt
• Wayne State

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Phase 1 - Hypotheses

• The quality of patient-provider communication
  will be associated with clinical measures,
  including receipt of HAART, adherence to HAART,
  and clinical outcomes (viral suppression and CD4
  level on HAART) and
• Disparities in the quality of communication
  between patients and providers will exist
  comparing non-Hispanic white with
  African-American HIV-infected patients.

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Phase 1 Data Collection

• Baseline survey for the provider
• Audio recording of a scheduled health care visit
• Face-to-face interview of the patient by a
  trained interviewer after the visit
• Brief questionnaire for the provider after the
  visit
• Abstraction of selected data from patients
  medical records and
• Analysis of audio recording and patient and
  providers questionnaires at the ETAC.

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Phase 1 Data Collection
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Phase 1 Inclusion Criteria

• Inclusion Criteria (Patients)
• HIV-infected patient of the HIV clinic
• Capable of understanding and giving written
  informed consent
• Age gt 20 years old
• English-speaking
• African-American (or people of African descent
  living in the United States), Hispanic, or
  non-Hispanic White race/ethnicity
• Has had at least one prior visit with that
  provider
• Inclusion Criteria (Providers)
• Currently providing primary care to at least 10
  HIV-infected patients in the clinic
• Physician, Nurse-Practitioner, or
  Physician-Assistant
• Agree to give written informed consent.

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Phase 1 Planned Enrollment
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Phase 1 Provider Surveys

• BASELINE
• patient-centered orientation,
• cultural competence,
• provider well-being,
• interracial anxiety,
• implicit racial bias,
• empathy,
• demographics
• POST-ENCOUNTER
• Cultural similarity
• Positive regard for patient

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Phase 1 Audiotapes

• One baseline encounter between patient and
  provider audiotapes
• Analyzed using Roter Interaction Analysis System
  (RIAS)

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Examples of RIAS Codes
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Phase 1 Patient Survey

• communication quality with HIV provider,
• perceived access and coordination of care,
• cultural dissimilarity,
• interracial anxiety,
• health literacy,
• trust (interpersonal and institutional),
• overall satisfaction with care,
• social support,
• health beliefs,
• self-efficacy,
• substance abuse,
• medication adherence,
• perceived discrimination

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Estimated Subject Effort and Compensation

• Providers
• 250
• One baseline survey (20 minutes)
• 10 post-encounter surveys
• Patients 50
• One baseline survey (1hour)

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Next Steps

• Develop Interventions
• Patients and/or providers
• Guided by analysis of data collected in Phase 1
• Where are the disparities?
• What has the biggest impact on healthcare process
  and health outcomes?