# AdvanCing High quality COPD care for people with immune dysfunction by implementing Evidence-based management through proactive E-consults (ACHIEVE)

> **NIH NIH U01** · SEATTLE INST FOR BIOMEDICAL/CLINICAL RES · 2021 · $658,660

## Abstract

Abstract
As HIV-infected (HIV+) patients age, chronic obstructive pulmonary disease (COPD) is one of the most
prevalent comorbid diseases. Of concern among patients with HIV infection, COPD confers substantial
morbidity and is associated with increased mortality. Yet, COPD is underdiagnosed and often inappropriately
managed in HIV+ patients, likely worsening the morbidity associated with COPD. Optimizing the management
of COPD includes improving uptake of recommended and discontinuation of ineffective and harmful practices.
Accurate diagnosis of COPD can identify individuals who will benefit – and those who will not benefit – from
COPD therapies. Appropriate use of long-acting inhalers to control COPD improves symptoms, health-related
quality of life, functional status, and decrease risk for exacerbations. Discontinuation of inappropriate inhalers –
particularly inhaled corticosteroids – can minimize harms from side effects that may be particularly problematic
in HIV+ persons, given their concomitant immuno-compromise, multimorbidity, and polypharmacy. We propose
to test an intervention to optimize COPD care that promotes effective, evidence-based care and de-implements
inappropriate therapies for COPD in HIV+ patients. We are a multidisciplinary team of key stakeholders and
investigators with expertise in COPD, HIV and implementation science, with prior experience studying similar
interventions. The intervention, grounded in the chronic care model, facilitates specialist support of primary
care, which includes infectious disease (ID) physicians who serve as the primary care providers for their HIV+
patients in the ID clinic. Rather than relying on referral-driven specialty care, which may be a barrier to access,
we will have pulmonologists proactively support HIV providers to manage a population of HIV+ patients with
COPD, delivering real-time evidence-based recommendations tailored to the individual HIV+ patient. We will
leverage the Department of Veterans Affairs (VA) clinical and informatics infrastructures to communicate
between team members developing the recommendations and patients' clinical providers through the
electronic health record as a proactive (i.e., pulmonary-initiated) E-consult. To offset potential increases in ID
providers' workload, we will draft recommendations as preliminary orders for providers to review and endorse
(sign), modify or cancel at their discretion, preserving autonomy. We will use a modified stepped-wedge
intervention design, with outcomes evaluated using the RE-AIM (Reach, Effectiveness, Adoption,
Implementation and Maintenance) framework. We will evaluate barriers and facilitators of optimal COPD care
for HIV+ patients, and of effective adoption, implementation and maintenance of a proactive E-consult
program, guided by the Consolidated Framework for Implementation Research. This intervention can enhance
the sustainable uptake of proven-effective interventions into routine clinical practice for HIV+ patient...

## Key facts

- **NIH application ID:** 10169500
- **Project number:** 5U01HL142103-04
- **Recipient organization:** SEATTLE INST FOR BIOMEDICAL/CLINICAL RES
- **Principal Investigator:** David H Au
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $658,660
- **Award type:** 5
- **Project period:** 2018-08-15 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10169500

## Citation

> US National Institutes of Health, RePORTER application 10169500, AdvanCing High quality COPD care for people with immune dysfunction by implementing Evidence-based management through proactive E-consults (ACHIEVE) (5U01HL142103-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10169500. Licensed CC0.

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