Project 1: Primary Care

项目 1：初级保健

• 批准号: 10202404
• 负责人: DAVID CURTIS MOHR
• 金额: $ 27.69万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10202404
• 关键词: Academic Medical Centers; Adoption; Age; Alcohol consumption; Algorithms; Anxiety; Behavior; Behavioral; Car Phone; Caring; Case Manager; Characteristics; Circadian Rhythms; Clinic; Cluster randomized trial; Communication; Communication Tools; Communities; Competence; Data; Effectiveness; Ethnic Origin; Failure; Family Practice; Feeling suicidal; Goals; Health Status; Income; Information Management; Intelligence; Intervention; Investigational Therapies; Location; Manuals; Medicine; Mental Depression; Mental Health; Methods; Modeling; Moods; Morbidity - disease rate; Online Systems; Patient Care; Patients; Pattern; Persons; Pharmacology; Pharmacotherapy; Physical activity; Physicians; Primary Health Care; Process; Protocols documentation; Quality of life; Race; Randomized Controlled Trials; Research; Research Project Grants; Services; Severities; Sleep; Technology; Telephone; Textiles; Time; Visit; Voice; Work; anxiety symptoms; arm; base; behavior change; care coordination; care providers; care systems; collaborative care; cost; dashboard; design; effectiveness implementation study; effectiveness implementation trial; health care settings; improved; innovation; mobile application; mortality; primary care setting; primary outcome; process optimization; programs; psychoeducation; psychologic; racial and ethnic; remote delivery; satisfaction; secondary outcome; sensor; sensor technology; sleep pattern; social; substance use; technology validation; therapy design; tool; usability; user centered design

Abstract Technology-enabled services (TESs), which use web-based and mobile applications supported by low- intensity coaching or care-management, have shown great potential, with a large number of randomized controlled trials consistently demonstrating efficacy. However, the many attempts to implement these validated interventions into large value-based care systems have failed. There are two broad reasons for these failures. First, patients in real world settings simply do not use the tools that were developed in research settings. Second, TESs have not been designed to fit into the workflows in general medicine practices. This research project will use a comprehensive user centered design approach to engage patients, care managers (CMs) and physicians in the design of a TES—comprised of technologies, CM service protocol, and implementation plan—that can be successfully deployed in a collaborative care program in family medicine clinics. The overall TES will be designed to support the existing collaborative care model, facilitating the acquisition of ongoing depression assessments from patients and communication with prescribing physicians. The design innovation focus of this research project will be to design a patient app that is simple, usable, useful, and fits into the fabric of people’s lives. We will harness ongoing research efforts in our Center in personal sensing, which use passively collected data from mobile phones to identify behaviors relevant to depression in real time. To date, we have created algorithms that reliably identify GPS mobility patterns, physical activity, locations visited, sleep patterns, and in-phone communication patterns, all of which track behaviors related to depression. This project will design patient interfaces that can represent this sensed information to patients in ways that are easily understandable, and that nudge people to increase positive activities, decrease depressogenic behaviors, and explore the relationship between behaviors and mood. We will use a behavior activation framework for the design of the intervention protocol. The TES will also include a CM dashboard that provides visibility into patient app use, as well as communication tools that allow the CM to provide low intensity support to the patient and communicate with the physician around pharmacotherapy needs. The effectiveness and implementation of the TES will be evaluated in a roll out cluster randomized trial across 4 primary care clinics This project will be the first to integrate the emerging capabilities of personal sensing into intervention apps. The resulting TES has the potential to be the first that is usable by real world patients, fits into clinic workflows, and can be successfully implemented in a general medicine collaborative care program.

摘要 技术支持的服务（TES），使用基于网络的应用程序和移动的应用程序，由低成本的 强度教练或护理管理，已显示出巨大的潜力，有大量的随机 对照试验始终证明有效性。然而，实施这些验证的许多尝试 对基于价值观的大型护理系统的干预失败了。这些失败有两大原因。 首先，真实的世界中的患者根本不使用在研究环境中开发的工具。 其次，TES的设计并不适合一般医学实践的工作流程。本研究 项目将采用全面的以用户为中心的设计方法，让患者、护理经理（CM） 和医生在设计一个TES-包括技术，CM服务协议，和实施 计划，可以成功地部署在家庭医学诊所的协作护理计划。整体 工商业污水附加费将被设计为支持现有的合作护理模式，促进收购正在进行的 患者的抑郁评估以及与处方医生的沟通。设计创新 该研究项目的重点将是设计一个简单，可用，有用的患者应用程序，并适合 人们生活的结构。我们将利用我们中心正在进行的个人感知研究， 被动地从移动的电话收集数据，以真实的时间识别与抑郁症相关的行为。到目前为止， 我们已经创造了可靠的算法来识别GPS移动模式，身体活动，访问的位置，睡眠 模式和电话交流模式，所有这些都可以追踪与抑郁症相关的行为。这个项目 将设计患者接口，可以以容易的方式向患者表示这种感测信息， 这是可以理解的，它促使人们增加积极的活动，减少抑郁行为， 探索行为和情绪之间的关系。我们将使用一个行为激活框架， 干预方案的设计。TES还将包括一个CM仪表板，提供对以下内容的可见性： 患者应用程序使用，以及允许CM为患者提供低强度支持的通信工具。 与患者沟通，并与医生就药物治疗需求进行沟通。的有效性和 将在4个初级保健诊所开展的随机分组试验中评估TES的实施情况 该项目将是第一个将新兴的个人感知功能集成到干预应用程序中的项目。 由此产生的TES有可能成为第一个可由真实的世界患者使用的TES，适合临床工作流程， 并且可以在一般医学协作护理方案中成功地实施。