iEAT: Information Technology to Enhance Anorexia Treatment

描述（由申请人提供）：神经性厌食症（AN）住院治疗后的复发率和再入院率高得令人无法接受，给患者和家庭成员带来了重大的经济、心理和社会负担。我们建议应用健康信息技术（HIT）服务，以连接更高水平的护理（即，住院治疗、部分住院治疗、住院治疗）和门诊治疗，目的是减少复发和再入院。本提案是对RFA-PA-09-164“NIH探索性/发展性研究资助计划（父R21）”的回应，描述了基于iPhone的HIT服务iEAT的开发和可行性测试：增强厌食症治疗的信息技术，该服务将作为AN患者及其提供者的自我监测和沟通工具。向门诊护理的过渡的特点是提供者接触的急剧减少以及对潜在触发环境因素的暴露增加。通过提供这种自我监测和沟通桥梁，我们的目标是减轻护理水平之间的过渡。iEAT将通过允许患者和提供者监测和管理AN相关症状和行为来增加每周门诊治疗，从而增加和改善患者自我护理以及与其提供者的沟通。我们将分3个阶段开发IEAT，每个步骤都涉及利益相关者（患者和提供者）。在第一阶段，我们会与病人和医疗服务提供者进行深入访谈，以全面了解他们的需要，并发展网上医管局服务。在第二阶段，我们将对4名患者及其提供者进行测试。反馈将告知应用程序的最终版本，然后将在第3阶段对10名患者及其提供者进行非对照试验。患者将在出院前接受iEAT iPhone的使用培训，提供者将通过iPhone或网络界面参与。患者将输入日常饮食交流，想法，情绪和限制和清除的冲动，以及第1阶段和第2阶段测试中出现的其他变量。患者将收到基于其输入的自动反馈消息，当输入丢失时的提示，来自其提供者的预定个性化反馈，以及关于治疗目标进展的每周治疗团队反馈。iEAT将允许患者和提供者查看其每日条目的摘要以及在每周门诊访视期间收集的临床数据（例如，体重，自我报告测量）。在出院后4个月，将根据条目的有效性、依从性、数据条目随时间推移的频率和质量以及患者和提供者关于其效用和可接受性的报告对iEAT进行评价。iEAT将在随后的大型随机对照试验中进行正式测试，以确定它是否能增强出院后治疗目标的维持并减少再入院。iEAT有可能简化护理级别之间的过渡，并提供一种具有成本效益和用户友好的方法，以增加患者与提供者的联系，增强症状的自我监测，并减少AN患者的再入院率。 公共卫生相关性：神经性厌食症（AN）的治疗费用昂贵，并且经常复发和再次住院。iEAT有可能简化护理级别之间的过渡，并提供一种具有成本效益和用户友好的方法，以增加患者与提供者的联系，增强症状的自我监测，并减少AN患者的再入院率。这里开发的技术将通过其他移动的电话平台提供，并随时可以修改，用于管理其他精神病和医疗状况。

DESCRIPTION (provided by applicant): Relapse and readmission rates after hospital-based treatment of anorexia nervosa (AN) are unacceptably high, placing a major financial, psychological, and social burden on patients and family members. We propose the application of a Health Information Technology (HIT) service to bridge the transition between higher levels of care (i.e., inpatient, partial hospitalization, residential) and outpatient care with the goal of reducing relapse and readmission. This proposal in response to RFA-PA-09-164 "NIH Exploratory/Developmental Research Grant Program (Parent R21)", describes the development and feasibility testing of an iPhone-based HIT service, iEAT: Information Technology to Enhance Anorexia Treatment, that will serve as a self-monitoring and communication tool for patients with AN and their providers. The transition to outpatient care is marked by a dramatic decrease in provider contact and increased exposure to potentially triggering environmental factors. By providing this self-monitoring and communication bridge, we aim to ease the transition between levels of care. iEAT will augment weekly outpatient treatment by allowing patients and providers to monitor and manage AN-related symptoms and behaviors thereby increasing and improving patient self-care and communication with their providers. We will develop IEAT in 3 stages involving stakeholders (patients and providers) at each step. In Stage 1, we will conduct in-depth interviews with patients and providers to fully understand needs and develop iEAT. In Stage 2, we will beta-test the program with 4 patients and their providers. Feedback will inform the final version of the application which will then be tested in Stage 3 in an uncontrolled trial of 10 patients and their providers. Patients will be trained in the use of the iEAT enabled iPhones prior to hospital discharge and providers will participate via iPhone or web interface. Patients will input daily entries of dietary exchanges, thoughts, mood, and urges to restrict and purge, as well as other variables that emerge from Stage 1 and 2 testing. Patients will receive automated feedback messages based on their entries, prompts when entries are missed, scheduled individualized feedback from their provider, and weekly treatment team feedback regarding progress towards treatment goals. iEAT will allow patients and providers to view summaries of their daily entries as well as clinical data collected during weekly outpatient visits (e.g., weight, self-report measures). At four months post-discharge, iEAT will be evaluated based on validity of entries, adherence, frequency and quality of the data entries over time, as well as patient and provider reports on its utility and acceptability. iEAT will then be tested formally in a subsequent larger randomized controlled trial to determine whether it enhances post-discharge maintenance of treatment goals and decreases readmission. iEAT has the potential to ease the transition between levels of care and provide a cost-effective and user- friendly approach to increase patient-provider contact, enhance self-monitoring of symptoms, and decrease hospital readmission for individuals with AN. PUBLIC HEALTH RELEVANCE: Treatment for anorexia nervosa (AN) is expensive and is marked by frequent relapse and re-hospitalization. iEAT has the potential to ease the transition between levels of care and provide a cost-effective and user- friendly approach to increase patient-provider contact, enhance self-monitoring of symptoms, and decrease hospital readmission for individuals with AN. The technology developed here will be made available through other mobile phone platforms and readily modifiable for management of other psychiatric and medical conditions.