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.

抽象的 支持技术的服务（TESS），使用基于Web的基于Web的应用程序和移动应用程序。 强度指导或护理管理表现出巨大的潜力，并有大量随机 对照试验始终证明效率。但是，实施这些验证的许多尝试 对大型基于价值的护理系统的干预失败了。这些失败有两个广泛的原因。 首先，现实世界中的患者根本不使用在研究环境中开发的工具。 其次，苔丝尚未旨在适应通用医学实践中的工作流程。这项研究 项目将采用全面的用户以用户为中心的设计方法来吸引患者，护理经理（CMS） 以及TES设计的医生 - 技术，CM服务协议和实施 计划 - 可以成功部署在家庭医学诊所的协作护理计划中。总体 TE将旨在支持现有的协作护理模型，并支持持续的收购 患者的抑郁评估以及与处方医生的沟通。设计创新 该研究项目的重点是设计一个简单，可用，有用并适合于 人们生活的结构。我们将利用我们的个人感应中心进行的研究工作，使用 被动地从手机收集的数据，以实时确定与抑郁症相关的行为。迄今为止， 我们创建了可靠地识别GPS移动性模式，体育锻炼，访问的位置，睡眠的算法 模式和手机通信模式，所有这些轨道行为与抑郁症有关。这个项目 将设计患者界面，可以以容易的方式向患者表示这些感知的信息 可以理解的，并且推动人们增加积极的活动，减少抑郁症的行为以及 探索行为与情绪之间的关系。我们将使用行为激活框架 干预协议的设计。 TES还将包括一个CM仪表板，可提供可见性 患者应用程序的使用以及允许CM提供低强度支持的通信工具 患者并与药物治疗需求的物理沟通。有效性和 TE的实施将在4个初级保健诊所的启动集群随机试验中进行评估 该项目将是第一个将个人传感的新兴功能集成到干预应用程序中的项目。 由此产生的TE有可能成为现实世界患者可用的第一个，适合诊所工作流程， 并且可以在一般医学协作计划中成功实施。