Virtual Patient Simulation in HIV: An Online Educational Tool to Improve Evidence-Based Clinical Decision-Making

BACKGROUND: Approximately 1.2 million people in the United States are living with HIV. Although an HIV-positive individual taking antiretroviral therapy (ART) is now expected to live into their early 70s, fewer than 50% of people living with HIV receive regular care, and only 25% achieve viral suppression. This study evaluated the impact of virtual patient simulation (VPS)-based education on the ability of Infectious Disease (ID)/HIV specialists and HIV Primary Care Physicians (PCPs) to develop appropriate patient care strategies. METHODS: The VPS consisted of 2 cases presented in an immersive environment that allowed clinicians to assess the patient, review electronic health records, and make open-ended decisions from an extensive database of diagnostic and treatment possibilities matching the scope and depth of clinical practice. The clinical decisions made by the participants were analyzed using a sophisticated decision engine, which provided instantaneous, personalized clinical guidance for user choices and errors of omission based on the current evidence-base and expert faculty recommendations. Educational impact was assessed using a 2-tailed paired T-test to compare participant decision data after clinical guidance with each individual’s baseline data. The VPS launched online on April 26, 2016. RESULTS: A total of 22,842 HCPs, including 356 ID specialists, 1798 HIV PCPs, 1378 nurse practitioners (NPs), and 16,437 nurses participated in the VPS as of April 28, 2017. This subset analysis presents data for ID specialists who participated during the first 2 months following the online launch of the VPS. Clinical Guidance (CG) which was provided as a part of the VPS experience led to significant (P < .05) gains with respect to ART initiation, provision of preventive care, and management of HIV/HCV coinfection (Figure). CONCLUSION: Participation in this VPS significantly improved the ability of ID specialists to make evidence-based decisions in the care of HIV. The findings also uncovered educational needs that warrant further interventions, including staging fibrosis, providing appropriate vaccinations, and initiating treatment. Additional analyses evaluating a larger cohort of providers and correlations between care parameters are ongoing. DISCLOSURES: S. Hurst, Medscape Education: Employee, Salary; D. Blevins, Medscape Education: Employee, Salary