Accuracy of progress monitoring decision rules to evaluate response to instruction with two computer adaptive tests.

Computer adaptive tests have become popular assessments to screen students for academic risk. Research is emerging regarding their use as progress monitoring tools to measure response to instruction. We evaluated the accuracy of the trend-line decision rule when applied to outcomes from a frequently used reading computer adaptive test (i.e., Star Reading [SR]) and frequently used math computer adaptive test (i.e., Star Math [SM]). Analyses of extant SR and SM data were conducted to inform conditions for simulations to determine the number of assessments required to yield sufficient sensitivity (i.e., probability of recommending an instructional change when a change was warranted) and specificity (i.e., probability of recommending maintaining an intervention when a change was not warranted) when comparing performance to goal lines based upon a future target score (i.e., benchmark) as well as normative comparisons (50th and 75th percentiles). The extant dataset of SR outcomes consisted of monthly progress monitoring data from 993 Grade 3, 804 Grade 4, and 709 Grade 5 students from multiple states in the United States northwest. Data for SM were also drawn from the northwest and contained outcomes from 518 Grade 3, 474 Grade 4, and 391 Grade 5 students. Grade level samples were predominately White (range = 59.89%-67.72%) followed by Latinx (range = 9.65%-15.94%). Results of simulations suggest that when data were collected once a month, seven, eight, and nine observations were required to support low-stakes decisions with SR for Grades 3, 4, and 5, respectively. For SM, nine, ten, and eight observations were required for Grades, 3, 4, and 5, respectively. Given the length of time required to support reasonably accurate decisions, recommendations to consider other types of assessments and decision-making frameworks for academic progress monitoring are provided.

Chronic High Risk Prescription Opioid Use Among Persons With HIV.

Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016-December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.

A mobile health intervention in HIV primary care: supporting patients at risk for ART non-adherence.

Mobile health (mHealth) interventions that are integrated in HIV clinical settings to facilitate ongoing patient-provider communication between primary care visits are garnering evidence for their potential in improving HIV outcomes. Rango is an mHealth intervention to support engagement in HIV care and treatment adherence. This study used a single-arm prospective design with baseline and 6-month assessments for pre-post comparisons, as well as a matched patient sample for between-group comparisons to test Rango's preliminary efficacy in increasing viral suppression. The Rango sample (n = 406) was predominantly 50 years of age or older (63%; M = 50.67; SD = 10.97, 23-82), Black/African-American (44%) or Hispanic/Latinx (38%), and male (59%). At baseline, 18% reported missing at least one dose of ART in the prior three days and chart reviews of recent VL showed that nearly 82% of participants were virally suppressed. Overall 95% of the patients enrolled in Rango returned for a medical follow-up visit. Of the 65 unsuppressed patients at baseline who returned for a medical visit, 38 (59%) achieved viral suppression and only 5% of the suppressed group at baseline had an increase in viral load at 6 months despite being at risk for ART non-adherence. While viral suppression was similar between Rango participants and patients receiving treatment as usual over the same time period, it is unknown whether those patients were similarly at risk for non-adherence. Our findings support efforts to formally test this innovative approach in addressing ART non-adherence and viral suppression particularly to reach HIV treatment goals.