Improving Teen Care with HIT

说明（由申请人提供）：青少年发病和死亡的大部分原因是参与了危害健康的行为，如酗酒和使用其他药物、吸烟、没有采取预防怀孕或性传播疾病措施的性活动、不健康的饮食模式和缺乏体育活动。这些行为通常始于青春期，然后持续到成年期，因此也影响成年人的健康、疾病、残疾、医疗负担和过早死亡。认识到这些行为对青少年和成人健康的影响，多个组织的专业实践指南建议初级保健提供者筛查这些行为，并提供旨在预防和减少风险的咨询。尽管有这些建议，而且每年有70%以上的青少年接受初级保健治疗，但在初级保健机构中，存在健康危险行为的青少年未被充分识别，而且很少得到减少风险咨询或后续干预措施以降低其风险。为了解决推荐护理的这一差距，我们建议开发和测试基于网络的交互式健康评估（iHA），以便在青少年就诊之前在初级保健机构中实施。iHA的目的是：1)进行多重风险筛查；2)提供个性化的以青年为重点的预防和减少风险反馈；3)总结结果，以及青少年报告的初级保健提供者（pcp）的风险行为、目标和后果，以促进患者与提供者的讨论；4)为pcp提供决策支持，以确定下一步适当的护理步骤。个性化反馈（上文第2部分）是这一拟议干预措施的一个创新特征，因为它已证明在减少年轻人危险饮酒方面具有强大的有效性，但尚未在青少年中进行测试，也未推断出医疗机构中物质使用以外的健康行为。《国际卫生条例》涵盖的卫生领域包括酒精、烟草和吸毒；身体活动;饮食;性的健康;和安全。拟议的研究将从六个初级保健诊所招募13-18岁的青少年样本。在第一阶段，我们将在对青少年和初级保健提供者进行正式可用性测试的基础上，优化iHA的设计和内容，并将制定实施流程和培训材料，以促进iHA在初级保健环境中的无缝整合。在第二阶段，我们对300名青少年进行了一项随机对照试验，以检验该iHA在医疗保健访问期间增加预防和减少风险咨询的有效性，以及在1个月和6个月的随访中减少各种青少年健康风险行为的有效性。

DESCRIPTION (provided by applicant): Most of the causes of adolescent morbidity and mortality result from participation in health risk behaviors, such as alcohol and other drug use, smoking, sexual activity without use of protection against pregnancy or sexually transmitted diseases, and unhealthy eating patterns and physical inactivity. These behaviors frequently begin during adolescence and then persist into adulthood, thereby also influencing adult health, disease, disability, healthcare burden, and premature death. In recognition of the impact of these behaviors on adolescent and adult health, professional practice guidelines from multiple organizations recommend that Primary Care Providers screen for these behaviors and provide counseling aimed at prevention and risk reduction. Despite these recommendations and the fact that over 70% of adolescents are seen in primary care each year, adolescents with health risk behaviors are underidentified in primary care settings, and are seldom provided with risk reduction counseling or follow up interventions to decrease their risks. To address this gap in recommended care, we propose to develop and test a web-based interactive Health Assessment (iHA) for implementation in primary care settings prior to adolescent healthcare visits. The iHA is designed to: 1) conduct multi-risk screening; 2) provide personalized youth-focused prevention and risk reduction feedback; 3) summarize results, in addition to youth-reported risk behaviors, goals, and consequences for Primary Care Providers (PCPs) in order to stimulate patient-provider discussions; and 4) provide decision support for PCPs in determining the next appropriate steps in care. Personalized feedback (component #2 above) is an innovative feature of this proposed intervention, as it has demonstrated robust effectiveness in reducing risky drinking among young adults, but has not yet been tested with adolescents, nor extrapolated to health behaviors beyond substance use in healthcare settings. Health areas covered by the iHA include alcohol, tobacco and drug use; physical activity; diet; sexual health; and safety. The proposed study will recruit a sample of adolescents aged 13-18 from six primary care clinics. In Phase 1, we will optimize the iHA design and content based on formal usability testing with adolescents and primary care providers, and will develop implementation processes and training materials to promote seamless integration of iHA in primary care settings. In Phase 2, we conduct a randomized, controlled trial with 300 adolescents to examine the efficacy of this iHA on increasing the provision of prevention and risk reduction counseling during the healthcare visit, and on reducing a variety of adolescent health risk behaviors at 1 and 6 month follow ups, relative to usual care.