A Digital Patient Decision Aid to Increase Sexually Transmitted Infection Testing in the Emergency Department: The STIckER Study

数字患者决策辅助工具可增加急诊科的性传播感染检测：STIckER 研究

• 批准号: 10432939
• 负责人: Lauren Stephanie Chernick
• 金额: $ 24.63万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-05 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10432939
• 关键词: Accident and Emergency department; Address; Adolescent and Young Adult; Adult; Affect; African American; Bioinformatics; Biometry; Black race; Caring; Centers for Disease Control and Prevention (U.S.); Childhood; Chlamydia; Clinic; Clinical; Clinical Trials; Code; Color; Communities; Contraceptive Usage; Data; Decision Aid; Decision Making; Detection; Development; Disease; Emergency Care; Emergency Department patient; Emergency Medicine; Emergency department visit; Enrollment; Epidemic; Evaluation; Failure; Feedback; Female; Genital; Genitalia; Genitourinary system; Goals; Gonorrhea; HIV Infections; Health; Health education; Hispanic; Infertility; Intervention; Interview; Knowledge; Lead; Learning Module; Malignant Neoplasms; Medical; Minority; Mission; Oropharyngeal; Outcome; Outpatients; Parents; Patient Preferences; Patients; Perinatal; Population; Positioning Attribute; Prevention approach; Probability; Process; Provider; Randomized; Recommendation; Recording of previous events; Reproducibility; Research; Resources; Scanning; Sexual Health; Sexual and Gender Minority Youth; Sexually Transmitted Diseases; Source; Specific qualifier value; Testing; Time; Training; Underserved Population; United States; United States National Institutes of Health; Ursidae Family; Woman; Work; aged; base; burden of illness; condoms; cost; design; digital; digital health; digital intervention; efficacy outcomes; evidence base; evidence based guidelines; fetal; heuristics; implementation barriers; implementation science; improved; infection rate; infection risk; innovation; men; multidisciplinary; novel strategies; patient oriented; patient screening; pediatric emergency; prototype; racial minority; randomized trial; recruit; screening; sex; sexual health intervention; sexually active adolescent; shared decision making; socioeconomic disadvantage; symptomatology; tool; treatment as usual; usability

ABSTRACT Improved screening for sexually transmitted infections (STI) is essential to reversing the STI epidemic in the United States (US). Nearly half of STIs in the US occur in adolescent and young adults (AYA) aged 15-24, and failure to perform genitourinary and extra-genital (anorectal and oropharyngeal) STI testing contributes to the propagation of disease. Emergency Departments (ED) care for over 17 million AYA each year, the majority being poor and minority. Our prior work demonstrated the inconsistent use of contraceptives among this population, and how, although ED providers are receptive to ED-based sexual health interventions, implementation barriers persist, such as limited time and resources. Innovative interventions are needed that fit efficiently within the ED workflow and maximize appropriate STI testing. One such intervention would be a patient decision aid that informs and empowers AYA patients who may benefit from STI testing. Patient decision aids have been used to successfully facilitate shared decision-making in the ED for various clinical scenarios. We have gathered a multi- disciplinary team of experts in pediatric, adult, and emergency medicine, ED-based clinical trials, digital health, implementation science, biostatistics, and shared decision-making to develop STIckER (STI ChecK in the ER), an evidence-based, digital patient decision aid to facilitate STI testing in the ED using a shared decision-making approach. STIckER consists of three steps: (1) the patient “scanning the sticker” via a QR code leading to a non- judgmental sexual health screening assessment; (2) shared decision-making educational modules connecting personalized STI risk to evidence-based testing recommendations; and (3) facilitation of a patient-provider STI testing conversation using a confidential, color-coded digital infographic. The specific aims of this proposal are (1) To refine “STIckER,” our STI testing patient decision aid through an iterative development approach based on stakeholder feedback; (2) To conduct usability testing and finalize development of STIckER; and (3) To conduct a pilot randomized trial to examine the preliminary efficacy and implementation of STIckER in the ED. We hypothesize that sexually active AYA who interact with STIckER will more often undergo any STI testing compared with sexually active AYA who do not interact with STIckER. SIGINIFICANCE: An effective, automated digital intervention increasing STI testing can be utilized in other EDs as a reproducible means to promote the provision of evidence-based sexual health education, decrease STI rates, and improve AYA health outcomes throughout the US.

摘要 改善性传播感染（STI）的筛查对于扭转艾滋病毒/艾滋病的流行至关重要。 United States（US）.美国近一半的性传播感染发生在15-24岁的青少年和年轻人（AYA）中， 未能进行泌尿生殖道和生殖器外（肛门直肠和口咽）STI测试有助于 疾病的传播。急诊科（艾德）每年照顾超过1700万AYA，其中大多数是 穷人和少数族裔。我们之前的工作表明，这一人群中避孕药具的使用不一致， 以及尽管艾德提供者接受基于ED的性健康干预措施， 例如，有限的时间和资源。需要创新的干预措施，有效地适应艾德 工作流程和最大化适当的STI测试。一种这样的干预措施是患者决策辅助， 告知并授权可能从STI测试中受益的AYA患者。患者决策辅助工具已被用于 成功地促进了艾德在各种临床情况下的共同决策。我们聚集了一个多- 儿科、成人和急诊医学、基于ED的临床试验、数字健康、 实施科学、生物统计学和共同决策，以制定STIcker（ER中的STIKK）， 一种基于证据的数字化患者决策辅助工具，用于通过共享决策来促进艾德中的STI检测 approach. STICKER包括三个步骤：（1）患者通过QR码“扫描贴纸”， 判断性性健康筛查评估;（2）共享决策教育模块， 个性化的STI风险，以证据为基础的测试建议;（3）促进患者-提供者STI 使用保密的彩色数字信息图测试对话。这项建议的具体目标是 (1)为了完善“STIcker”，我们的STI测试患者决策辅助工具通过基于 （2）进行可用性测试，并完成STIcker的开发;以及（3） 进行一项试验性随机试验，以检查STIcker在ED中的初步疗效和实施情况。 我们假设，性活跃的AYA谁与STIcker互动将更经常地接受任何STI测试 与不与STICKER互动的性活跃的AYA相比。信号：一个有效的，自动化的 数字干预增加STI测试可以在其他ED中使用，作为一种可重复的手段， 提供循证性健康教育，降低性传播感染率，改善青少年健康结果 在整个美国。