Improving Adolescent Sexual Health Outcomes using Health Information Technology

利用健康信息技术改善青少年性健康结果

• 批准号: 10556365
• 负责人: Monika Kumari Goyal
• 金额: $ 77.73万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10556365
• 关键词: Accident and Emergency department; Acute; Address; Adherence; Adolescent; Affect; Black race; Cities; Clinical; Communities; Computers; Data; Data Reporting; Detection; Development; Diagnosis; Disparity; Effectiveness; Electronic Health Record; Electronics; Emergency Care; Emergency Department-based Intervention; Engineering; Epidemic; Fright; Future; General Population; Goals; Health; Health Services; Health Services Accessibility; Health Status; Health Technology; Healthcare; Hispanic; Human; Interruption; Intervention; Interview; Judgment; Measures; Mentored Patient-Oriented Research Career Development Award; Mission; Modeling; Not Hispanic or Latino; Outcome; Paper; Patient Outcomes Assessments; Patient-Centered Care; Patients; Pediatric Hospitals; Persons; Pilot Projects; Policies; Population; Privacy; Process; Public Health; Randomized; Reporting; Research; Resources; Risk; Risk Assessment; STI prevention; Series; Services; Sexual Health; Sexually Transmitted Diseases; Source; Surveys; Testing; Text Messaging; Time; Transportation; Visit; Work; Youth; adolescent sexual health; burden of illness; clinical decision support; clinical practice; computerized; cost; design; disparity reduction; health assessment; health care availability; health care disparity; health care quality; health disparity; health information technology; high risk; high risk population; high-risk adolescents; improved; infection management; infection rate; innovation; interest; mHealth; marginalization; outcome disparities; patient engagement; population health; pragmatic trial; process improvement; provider adherence; randomized trial; randomized, clinical trials; risk stratification; screening; shared decision making; social stigma; stem; text messaging intervention; tool; treatment adherence; treatment as usual; treatment program; trial design; two way texting; vulnerable adolescent

Project Abstract Adolescents account for nearly half of all new sexually transmitted infection (STI) cases annually, and of those, non-Hispanic Black and Hispanic youth are disproportionately affected. These disparities are attributed, in part, to differential access to and routine use of quality health care, including STI prevention and treatment. The overarching goal of our research efforts are to improve adolescent sexual health outcomes and mitigate disparities in STI rates by leveraging health information technology (HIT) in the emergency department (ED) to enable detection and treatment of STIs through shared decision making. The objective of this proposal is to scale and optimize our successful process in improving STI testing rates by leveraging HIT to: 1) seamlessly integrate broad-scale targeted STI screening through the provision of real-time, electronic health record embedded, clinical decision support (CDS) based on patient-reported STI-risk assessment into the normal ED workflow to improve STI detection and 2) use mobile Health (mHealth) to improve STI treatment rates. Building on our preliminary work, the specific aims are to: 1) use a human factors engineering approach to implement and optimize a broad-scale computer-facilitated STI screening process into the clinical workflow of the ED; 2) compare differences in STI detection rates between a sexual health screening (SHS)-derived electronic CDS strategy versus usual care (no provision of CDS); and 3) compare differences in treatment adherence between patients receiving text messages versus those receiving usual care (no text messages). Within the first aim, we will use a human factors engineering approach to conduct workflow analyses which will inform the refinement of implementation of an STI screening process into the clinical workflow of the ED. In the second aim, we will conduct a pragmatic trial using an interrupted time series design to measure the impact of SHS-derived electronic CDS on STI detection rates. In the third aim, we will conduct a randomized clinical trial, nested within the pragmatic trial, to measure the impact of a two-way text-messaging intervention to improve treatment rates through identifying and addressing barriers to STI treatment adherence. This innovative approach leverages HIT to electronically integrate patient-reported sexual risk data to guide CDS and mHealth to improve treatment adherence. We expect our contribution to help improve sexual health outcomes and reduce disparities in the burden of STIs among at-risk, vulnerable adolescents by increasing STI detection and treatment adherence. The proposed work is significant because it has the potential to improve the health of the millions of adolescents who access EDs as their only source of healthcare and impact national policies related to STI detection and treatment. In addition, this work can provide proof of concept for leveraging HIT to deliver patient-centered care with shared decision making to address health care disparities and improve healthcare quality and outcomes, which can be applied to other types of screening interventions in the future.

项目摘要 每年新增性传播感染 (STI) 病例中，青少年占近一半，其中， 非西班牙裔黑人和西班牙裔青年受到的影响尤为严重。这些差异部分归因于 差异化获得和常规使用优质医疗保健，包括性传播感染的预防和治疗。这 我们研究工作的总体目标是改善青少年性健康结果并减轻 通过利用急诊科 (ED) 的健康信息技术 (HIT) 来消除性传播感染率的差异 通过共同决策实现性传播感染的检测和治疗。该提案的目的是 通过利用 HIT 来扩展和优化我们在提高 STI 检测率方面的成功流程：1) 无缝 通过提供实时电子健康记录整合大规模有针对性的性传播感染筛查 基于患者报告的性传播感染风险评估的嵌入式临床决策支持 (CDS) 纳入正常急诊室 工作流程来改善性传播感染检测，2) 使用移动健康 (mHealth) 来提高性传播感染治疗率。建筑 我们前期工作的具体目标是：1）利用人因工程方法来实施 将大规模计算机辅助性传播感染筛查流程优化到急诊室的临床工作流程中； 2） 比较基于性健康筛查 (SHS) 的电子 CDS 之间 STI 检出率的差异 策略与常规护理（不提供 CDS）； 3）比较治疗依从性的差异 接收短信的患者与接受常规护理的患者（无短信）。在第一个目标中，我们 将使用人为因素工程方法进行工作流程分析，为改进提供信息 将 STI 筛查流程纳入 ED 的临床工作流程。在第二个目标中，我们将 使用中断时间序列设计进行务实试验来衡量 SHS 衍生的影响 关于 STI 检出率的电子 CDS。在第三个目标中，我们将进行一项随机临床试验，嵌套在 务实试验，衡量双向短信干预对提高治疗率的影响 通过识别和解决性传播感染治疗依从性的障碍。这种创新方法利用 HIT 以电子方式整合患者报告的性风险数据，以指导 CDS 和 mHealth 改进 治疗依从性。我们希望我们的贡献能够帮助改善性健康结果并减少 通过增加性传播感染的检测和 治疗依从性。拟议的工作意义重大，因为它有可能改善人们的健康 数以百万计的青少年将急诊室作为唯一的医疗保健来源，并影响相关国家政策 STI 检测和治疗。此外，这项工作可以为利用 HIT 提供概念证明 以患者为中心的护理，通过共同决策来解决医疗保健差异并改善医疗保健 质量和结果，可以应用于未来其他类型的筛查干预措施。