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.

抽象的 改善性传播感染 (STI) 筛查对于扭转性传播感染在该地区的流行至关重要 美国（US）。在美国，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，并且 未能进行泌尿生殖和生殖器外（肛门直肠和口咽）性传播感染检测会导致 疾病的传播。急诊科 (ED) 每年照顾超过 1700 万 AYA，其中大多数是 穷人和少数民族。我们之前的工作表明该人群中避孕药具的使用不一致， 尽管急诊科提供者愿意接受基于急诊科的性健康干预措施，但实施障碍如何 坚持，例如有限的时间和资源。需要有效适应急诊科的创新干预措施 工作流程并最大化适当的 STI 测试。其中一种干预措施是患者决策辅助， 为可能从 STI 检测中受益的 AYA 患者提供信息并赋予他们权力。患者决策辅助工具已被用于 成功促进急诊室针对各种临床情况的共同决策。我们聚集了多方 由儿科、成人和急诊医学、基于急诊科的临床试验、数字健康、 实施科学、生物统计学和共同决策来开发 STIckER（急诊室中的 STI 检查）， 基于证据的数字化患者决策辅助工具，通过共享决策促进急诊科的性传播感染检测 方法。 STIckER 包含三个步骤：(1) 患者通过二维码“扫描贴纸”，从而获得非 判断性性健康筛查评估； (2) 共享决策教育模块连接 基于证据的检测建议的个性化性传播感染风险； (3) 促进患者-提供者性传播感染 使用机密的、颜色编码的数字信息图测试对话。该提案的具体目标是 (1) 通过基于迭代开发方法来完善“STIckER”，我们的 STI 测试患者决策辅助工具 利益相关者的反馈； (2) 进行可用性测试并完成STIckER的开发； (3) 至 进行一项随机试验，以检查 STIckER 在急诊室的初步疗效和实施情况。 我们假设与 STIckER 互动的性活跃 AYA 将更频繁地接受任何 STI 检测 与不与 STIckER 互动的性活跃 AYA 相比。意义：一种有效的、自动化的 增加性传播感染检测的数字干预可以在其他急诊室中作为一种可重复的手段来促进 提供循证性健康教育、降低性传播感染率并改善 AYA 健康结果 整个美国。