New Strategies in Clinical Guideline Delivery: Randomized trial of online, interactive decision-support versus guidelines for HIV treatment selection by trainees

Post Date: 
2020-03-25
Publication: 
Clinical Infectious Diseases
Summary: 

Background
Support for clinicians in HIV medicine is critical given national HIV-provider shortages. Department of Health and Human Services (DHHS) guidelines are comprehensive but complex to apply for antiretroviral therapy (ART) selection. HIV-ASSIST (www.hivassist.com) is a free tool providing ART decision-support that could augment implementation of clinical practice guidelines.

Methods
We conducted a randomized study of medical students and residents at Johns Hopkins University, in which participants were asked to select an ART regimen for 10 HIV case-scenarios through an electronic survey. Participants were randomized to receive either DHHS guidelines alone (with video tutorial), or DHHS guidelines and HIV-ASSIST (with video tutorial) to support their decision-making. ART selections were graded ‘appropriate’ if consistent with DHHS guidelines, or concordant with regimens selected by HIV experts at four academic institutions.

Results
Among 118 trainees, participants randomized to receive HIV-ASSIST had significantly higher percentage of appropriate ART selections compared to those receiving DHHS guidelines alone (% appropriate responses in DHHS vs HIV-ASSIST arms: median 40% [Q1, Q3: 30%, 50%] vs 90% [80%, 100%], p<0.001). This difference was consistent among both medical students (median 40% vs 90%, p<0.001) and residents (median 40% vs 90%, p<0.001). The effect was seen for all case-types, but most pronounced for complex cases involving ART-experienced patients with ongoing viremia (DHHS vs HIV-ASSIST: median 0% [0%, 33%] vs 100% [66%, 100%]).

Conclusion
Trainees using HIV-ASSIST were significantly more likely to choose appropriate ART regimens compared to those using guidelines alone. Interactive decision-support tools may be important to ensure appropriate implementation of HIV guidelines.

Citation: 
Ramirez JA, Maddali MV, Nematollahi S, Li JZ, Shah M. New strategies in clinical guideline delivery: Randomized trial of online, interactive decision-support versus guidelines for HIV treatment selection by trainees. Clin Infect Dis. Clinical Infectious Diseases, ciaa299, https://doi.org/10.1093/cid/ciaa299. Published: 25 March 2020.