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卫生保健提供者，提供了一个理想的机会，将行为/情感健康筛查纳入临床护理。然而，尽管有临床指导方针，提供者对青少年危险健康行为和抑郁症的筛查率始终低于建议的水平。需要新的策略来增加初级保健中的行为健康筛查。具有临床决策支持（CDS）的卫生信息技术在改善卫生保健质量和随后的青少年行为健康结果方面具有巨大潜力。虽然大多数青少年健康问题可以通过行为干预加以解决，而且大多数青少年都能自如地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纳入青少年护理。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。第二个研究领域侧重于医疗信息技术，以支持以患者为中心的护理。本探索性项目的主要目标是：1)开发一个基于理论的青少年互动行为/情绪健康模块，该模块可整合到卫生保健服务中，作为风险评估和干预工具，以促进青少年行为改变；2)在青少年初级保健中试点实施计算机化模块/筛选系统，评估临床医生、青少年和系统的结果。该研究将通过加州大学旧金山分校（UCSF）在旧金山湾合作研究网络（CRN）内进行。从这些种族和经济多样化的诊所中，将招募年龄在12至18岁之间的青少年样本参与研究的所有阶段。第一阶段（一年级）将侧重于开发一个计算机化的行为/情感健康模块，该模块可被青少年和在初级保健机构照顾他们的卫生专业人员所接受。第二阶段（第2年）将侧重于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个感兴趣的结果进行定量和定性分析。探索性R21提供了一个理想的机会来了解拟议的干预措施如何满足青少年的不同需求，告诉我们在不同的诊所环境中影响实施质量的环境因素，并为更大规模的IT实施提供适应和整合的策略。

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.