Dr. Dang is a Clinical Instructor of Medicine in the Section of Infectious Diseases at Baylor College of Medicine (BCM). She is also nearing completion of a postdoctoral fellowship in health services research at the Houston Veterans Affairs Health Services Research and Development Center of Excellence. Dr. Dang will be appointed Assistant Professor at BCM effective July 1, 2013. Her overarching goal is to succeed as an independent clinical investigator conducting meaningful, actionable research to improve the quality of HIV care. Specifically, she is interested in using patient experience metrics as an innovative focus for improving retention in HIV care and adherence to highly active antiretroviral therapy (HAART). Dr. Dang will accomplish these goals through mentored research with Dr. Thomas Giordano, a national expert on retention in HIV care, Dr. Robert Westbrook, a frequent industry consultant on customer satisfaction and retention, Dr. Christine Markham, a behavioral scientist with expertise in intervention development, and Dr. Amico, an internationally recognized expert on factors related to adherence and engagement in care for vulnerable populations with HIV. Mentored research with be supplemented with structured career development activities. Activities will include advanced, graduate-level coursework and/or directed readings in customer/patient evaluation and experience management, behavioral science and change theory, analysis of behavioral and social science data, and HIV retention and adherence. The proposed research in this K23 application seeks to understand the basic behavioral science of patient satisfaction as it relates to retention in HIV care and adherence to HAART. Furthermore, this research will identify mutable factors that shape how patients evaluate their HIV care, particularly those in underserved, minority populations. The overall hypothesis is that patients with higher satisfaction will have greater retention in HIV care and adherence to HAART. Applying mixed-methods, the Specific Aims are to: 1) understand how patients anticipate, experience and evaluate their HIV care by conducting longitudinal, in-depth interviews with patients new to clinic as their care unfolds in the first 6 months, 2) develop and pre-test a quantitative survey that comprehensively assesses HIV patient experience and satisfaction, 3) determine the relationship between overall patient satisfaction at baseline and retention in HIV care and adherence to HAART 12-months after entering care, and identify moderators of that relationship. The mentored research and career development activities proposed in this application will expand upon Dr. Dang's current skills and past work and allow her to evolve as an independent investigator with expertise in the use of patient experience metrics to strategically impact the quality of HIV care.
Poor retention in HIV care and suboptimal adherence to highly active antiretroviral therapy (HAART) remain major barriers to maximizing the benefit of effective treatment. Analogous to the business model of customer satisfaction and retention, patient satisfaction could serve as an innovative, patient-centered approach to improving retention in HIV care and adherence to HAART. Patients'evaluation of various attributes of the HIV care experience can serve as a powerful tool to identify areas where improvements in health services delivery will have the largest impact on patient satisfaction, retention, and adherence.