Integrating mHealth for Alcohol Use Disorders into Clinical Practice

项目摘要/摘要 移动健康(MHealth)技术(例如智能手机应用程序)有可能持续 监测患者并随时随地提供需要的干预措施。这些功能使mHealth 在治疗酒精和其他物质使用障碍方面特别有希望。患者提供的数据 来自mHealth设备的数据还可以帮助临床医生计划治疗和对患者做出反应。然而，移动健康很少 整合到治疗中，部分原因是可用的循证移动健康系统太少了。 该项目探讨了使用mHealth治疗小学酒精使用障碍(AUD)的可能性 护理诊所。推动该项目的两个问题：(1)是A-Chess，一个已经得到验证的mHealth系统 对离开住院治疗的AUD患者有效，对初级保健患者有效？(2) 将A-国际象棋整合到临床过程中的成本是值得的，还是对患者来说足够了 独立使用A-CHESS，无需集成到电子健康记录和临床医生监控中？ 该项目使用类型1混合设计(检查患者结果和实施)来 回答这些问题。患者将被随机分配到(1)对AUD的常规护理，(2)由临床医生调解 患者接受A-象棋的小组，临床医生监测患者提供的来自 集成到电子健康记录中的仪表板，或(3)以患者为导向的小组，其中临床医生只需 鼓励患者自主使用国际象棋。定量分析将考察两者之间的差异 在危险饮酒天数和生活质量组中检验假设，即患者在临床医生的调解下 与常规护理组相比，观察组患者的病情改善更明显。此外，我们假设 两个A-象棋组的患者在危险饮酒天数和生活质量方面将比 常规护理组和临床医生中介组的患者将看到最大的改善。 将进行分组分析，以了解结果与(1)性别，(2)之间的关系 患者和临床医生对A-棋产生的警报的反应，以及(3)A-棋的使用。定性的 分析将主要寻求了解临床医生如何使用仪表板来监控患者护理。半- 结构化访谈将询问仪表板使用量、潜在污染(是否 临床医生对其他两组患者使用仪表板建议的方法)，以及质量 干预措施的实施。最后，成本分析将确定将A-CHESS集成到临床的成本 实践与患者单独使用A-CHESS的成本，以及临床整合A-CHESS的成本是否- CHESS被减少的AUD相关护理(例如，住院、急诊室就诊、住院)节省的资金所抵消 治疗和戒毒)。这项研究将告知临床领导者和政策制定者是否以及如何 应该将移动健康系统纳入临床护理，以治疗AUD和潜在的其他慢性病。

Project Summary/Abstract Mobile health (mHealth) technologies (e.g., smartphone applications) have the potential to continuously monitor patients and deliver interventions when and where they are needed. These features make mHealth particularly promising for the treatment of alcohol and other substance use disorders. Patient-provided data from mHealth devices could also help clinicians plan treatment and respond to patients. Yet mHealth is rarely integrated into treatment, in part because so few evidence-based mHealth systems are available. This project addresses the potential of using mHealth to treat alcohol use disorder (AUD) in primary care clinics. Two questions drive the project: (1) Is A-CHESS, an mHealth system that has been proven effective for patients leaving residential treatment for AUD, effective with patients in primary care? (2) Are the costs associated with integrating A-CHESS into clinical processes worthwhile, or does it suffice for patients to use A-CHESS independently, without integration into the electronic health record and clinician monitoring? The project uses a Type 1 hybrid design (examining both patient outcomes and implementation) to answer these questions. Patients will be randomly assigned to (1) usual care for AUD, (2) a clinician-mediated group in which patients receive A-CHESS and clinicians monitor patient-supplied A-CHESS data from a dashboard integrated into the electronic health record, or (3) a patient-directed group in which clinicians simply encourage patients to use A-CHESS on their own. The quantitative analysis will examine differences between the groups in risky drinking days and quality of life to test the hypothesis that patients in the clinician-mediated group will have greater improvements than patients in the usual care group. Additionally, we hypothesize that patients in both A-CHESS groups will have greater improvements in risky drinking days and quality of life vs. patients in the usual care group, and those in the clinician-mediated group will see the greatest improvements. Subgroup analyses will be conducted to understand the relationship between the outcomes and (1) gender, (2) patient and clinician responses to alerts generated by A-CHESS, and (3) use of A-CHESS. The qualitative analysis will mainly seek to understand how clinicians use the dashboard to monitor patient care. Semi- structured interviews will inquire about the amount of dashboard use, potential contamination (whether clinicians used approaches suggested by the dashboard with patients in the other two groups), and the quality of intervention delivery. Finally, the cost analysis will determine the cost of integrating A-CHESS into clinical practice vs. the cost of patients using A-CHESS independently, and whether the cost of clinically integrating A- CHESS is offset by savings from reduced AUD-related care (e.g., hospitalizations, ER visits, residential treatment, and detoxification). This research will inform clinical leaders and policymakers on whether and how mHealth systems should be incorporated into clinical care to treat AUD and potentially other chronic diseases.