Improving Adolescent Primary Care Through An Interactive Behavioral Health Module

描述(由申请人提供)：大多数青少年每年去一次医疗保健提供者，这为将行为/情绪健康筛查整合到临床护理中提供了理想的机会。然而，尽管有临床指南，提供者对青少年危险健康行为和抑郁症的筛查比率始终低于建议。需要新的战略来增加初级保健中的行为健康筛查。健康信息技术和临床决策支持(CDS)具有巨大的潜力，可以改善青少年的医疗保健质量和随后的行为健康结果。虽然大多数青少年的健康问题都可以通过行为干预，而且大多数青少年都习惯于使用交互式计算机化技术，但很少有健康信息技术干预措施被整合到青少年护理中。拟议的项目主要涉及卫生信息技术的研究领域，以改善卫生保健决策，特别是在初级保健环境中开发和实施卫生信息工具。次要研究领域侧重于卫生信息技术，以支持以患者为中心的护理。这个探索性项目的主要目标是1)为青少年开发一个基于理论的互动行为/情绪健康模块，可以整合到卫生保健提供中，作为一种风险评估和干预工具，以促进青少年行为改变；以及2)在青少年初级保健中试行实施计算机化模块/筛查系统，评估临床医生、青少年和系统结果。这项研究将在旧金山湾合作研究网络(CRN)内通过加州大学旧金山分校(UCSF)进行。从这些种族和经济上不同的诊所，12岁至18岁的青少年样本将被招募参加研究的所有阶段。第一阶段(第一年)将侧重于开发一个电脑化的行为/情绪健康模块，该模块可为青少年和在初级保健环境中照顾他们的卫生专业人员所接受。第二阶段(第二年)将集中在两个初级保健诊所实施该模块，为大量不同的青少年患者提供服务。将利用多种方法和数据来源对每一项感兴趣的成果进行定量和定性分析。探索性的R21提供了一个理想的机会，以了解拟议的干预措施如何满足青少年的不同需求，告诉我们在不同的临床环境中影响实施质量的背景因素，并为更大规模的IT实施中的适应和整合战略提供信息。

DESCRIPTION (provided by applicant): Most adolescents visit a health care provider once a year, providing an ideal opportunity to integrate behavioral/emotional health screening into clinical care. Yet despite clinical guidelines, providers screen adolescents for risky health behaviors and depression at rates consistently lower than recommended. New strategies are needed to increase behavioral health screening in primary care. Health information technology, with clinical decision support (CDS) has tremendous potential to improve health care quality and subsequent behavioral health outcomes for adolescents. Although the majority of adolescent health problems are amenable to behavioral intervention, and most adolescents are comfortable using interactive computerized technology, few health information technology interventions have been integrated into adolescent care. The proposed project primarily addresses the research area of Health IT to improve health care decision-making, specifically the development and implementation of health information tools into the primary care setting. A secondary research area is focused on Health IT to support patient-centered care. The major goals of this exploratory project are 1) to develop a theoretically based interactive behavioral/emotional health module for adolescents that can be integrated into health care delivery, serving both as a risk assessment and an intervention tool to enhance adolescent behavior change; and 2) to pilot the implementation of the computerized module/screening system into adolescent primary care, assessing clinician, adolescent, and system outcomes. The study will be conducted within the San Francisco Bay Collaborative Research Network (CRN) through the University of California, S.F. (UCSF). From these ethnically and economically diverse clinics, a sample of adolescents, ages 12 to18 years, will be recruited to participate in all phases of the research. Phase 1 (Year 1) will focus on developing a computerized behavioral/emotional health module that is acceptable to teenagers and to health professionals who care for them in primary care settings. Phase 2 (Year 2) will focus on implementing the module into two primary care clinics serving large numbers of diverse adolescent patients. Multiple approaches and data sources will be utilized to conduct quantitative and qualitative analyses on each of the outcomes of interest. The exploratory R21 provides an ideal opportunity to understand how the proposed intervention addresses the diverse needs of teenagers, inform us about contextual factors that contribute to quality of implementation in varied clinic contexts, and inform strategies for adaptation and integration in larger scale IT implementation.