Improving HIV Care with mHealth Tools: An App to Detect Neurocognitive Impairment

使用移动医疗工具改善艾滋病毒护理：检测神经认知障碍的应用程序

• 批准号: 9037711
• 负责人: Reuben N Robbins
• 金额: $ 20.79万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9037711
• 关键词: AIDS prevention; Activities of Daily Living; Address; Adherence; Adult; Affect; Android; Attention; Behavior; Behavioral; Big Data; Caring; Case Manager; Chronic; Clinic; Clinical; Clinical Research; Communication; Computerized Medical Record; Data; Databases; Detection; Development; Device Designs; Disease; Early Diagnosis; Electronics; Ensure; Epidemiology; Equipment; Face; Foundations; Future; Good Clinical Practice; HIV; Health; Health Personnel; Health Services Accessibility; Health system; Healthcare; Home visitation; House Call; Human; Human Resources; Impairment; Individual; Instruction; Intervention; Learning; Life; Measures; Medical; Medical Electronics; Medical Records; Meta-Analysis; Methods; Monitor; Motor; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Nurses; Outcome; Paper; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Population; Population Database; Preventive Intervention; Primary Health Care; Provider; Public Health; Quality of life; Reaction Time; Research; Resources; Risk; Rural; Short-Term Memory; Specialist; Staging; System; Tablets; Testing; Time; Training; Treatment outcome; Viremia; antiretroviral therapy; base; clinical care; clinical practice; design; digital; handheld mobile device; implementation trial; improved; instrument; mHealth; medication compliance; memory process; mild neurocognitive impairment; mobile computing; mortality; novel; portability; prevention service; processing speed; screening; therapy adherence; tool; touchscreen; transmission process; treatment adherence; usability

 DESCRIPTION (provided by applicant): Neurocognitive impairment (NCI) is one of the most common clinical conditions seen in HIV, affecting as many as 70% of infected individuals, including those on antiretroviral therapy (ART) and with well-controlled viremia. The NCI seen in HIV has significant medical, functional, and public health consequences (e.g., problems adhering to ART), but often goes undetected in the clinical setting. Routine screening for HIV-related NCI can enhance provider-patient communication to help patients with NCI better manage their ART adherence and other health outcomes, but doing so faces challenges. For instance, most screening tools for NCI in HIV clinics are paper-and-pencil tests prone to administration and scoring errors that require highly trained personnel to administer, score and interpret, require additional equipment, and are not well-suited for modern clinics utilizing electronic medical records. To address this public health and medical practice gap, we have developed an mHealth tool to make screening more accessible and sustainable in the modern clinical setting. NeuroScreen is a brief, easy-to-use NCI screening test application (app) for Android mobile devices designed to be administered by a wide range of non-expert healthcare personnel. The app is highly automated (e.g., does not require any record keeping or scoring) with standardized instructions ensuring consistent administrations each and every time with minimal training. NeuroScreen is ultra-portable (i.e., usable in any clinic exam room, remote and rural settings, or during home visits) and totally self-contained (i.e., no need for paper forms, pens, stopwatches, or other apparatuses). Results from NeuroScreen are available immediately and can be transmitted electronically to a variety of end-users, such as primary care providers, HIV specialists and/or electronic medical records, as well as to databases for population level monitoring. This study will assess the usability and acceptability of a tablet-based NeuroScreen by HIV care providers of differing expertise levels (e.g., physicians, nurses, and case managers), and identify provider- and clinic-level facilitators and barriers to integrating this mHealth tool into clinical practice. The study will then evaluate NeuroScreen's accuracy to detect mild NCI in 182 HIV-infected adults with NCI (n=91) and without NCI (n=91). With an easy-to-use and accurate tool to detect NCI and well-suited for clinics using and moving towards electronic medical systems, early detection and on-going monitoring of impairment could be realized and help healthcare providers communicate more effectively with patients about their treatment and care, make better referrals, and offer tailored ART adherence interventions and strategies as well as HIV prevention services. Furthermore, NeuroScreen offers health systems a viable method to collect large quantities of neurocognitive data suited to population level epidemiological research and other studies utilizing big data. An mHealth tool, like NeuroScreen, could be easily modified for use in other disease populations and regions of the world that rely on task-shifting due to very limited healthcare resources.

 描述（由申请人提供）：神经认知障碍 (NCI) 是 HIV 中最常见的临床病症之一，影响多达 70% 的感染者，包括接受抗逆转录病毒治疗 (ART) 和病毒血症控制良好的感染者。 HIV 中出现的 NCI 具有重大的医疗、功能和公共卫生后果（例如，坚持 ART 的问题），但在临床环境中常常未被发现。对 HIV 相关 NCI 进行常规筛查可以加强医患沟通，帮助 NCI 患者更好地管理其 ART 依从性和其他健康结果，但这样做面临挑战。例如，HIV 诊所中的大多数 NCI 筛查工具都是纸笔测试，容易出现管理和评分错误，需要训练有素的人员进行管理、评分和解释，需要额外的设备，并且不太适合使用电子病历的现代诊所。为了解决这一公共卫生和医疗实践差距，我们开发了一种移动医疗工具，使筛查在现代临床环境中更容易获得和可持续。 NeuroScreen 是一款简短、易于使用的 NCI 筛查测试应用程序 (app)，适用于 Android 移动设备，旨在由各种非专业医疗保健人员进行管理。该应用程序高度自动化（例如，不需要任何记录保存或评分），并具有标准化说明，可确保每次进行一致的管理，只需最少的培训。 NeuroScreen 非常便携（即可以在任何诊所检查室、偏远和农村环境或家访期间使用）并且完全独立（即不需要纸质表格、笔、秒表或其他设备）。 NeuroScreen 的结果可立即获得，并可通过电子方式传输给各种最终用户，例如初级保健提供者、艾滋病毒专家和/或电子病历，以及用于人口水平监测的数据库。这项研究将评估不同专业水平的 HIV 护理提供者（例如医生、护士和病例经理）对基于平板电脑的 NeuroScreen 的可用性和可接受性，并确定提供者和诊所层面的促进因素和障碍，以将该移动医疗工具整合到临床实践中。然后，该研究将评估 NeuroScreen 在 182 名患有 NCI（n=91）和无 NCI（n=91）的 HIV 感染成人中检测轻度 NCI 的准确性。借助易于使用且准确的工具来检测 NCI，并且非常适合使用和转向电子医疗系统的诊所，可以实现损伤的早期检测和持续监测，并帮助医疗保健提供者更有效地与患者沟通其治疗和护理，进行更好的转诊，并提供量身定制的 ART 依从干预措施和策略以及艾滋病毒预防服务。此外，NeuroScreen 为卫生系统提供了一种收集大量神经认知数据的可行方法，适合人口层面的流行病学研究和其他利用大数据的研究。像 NeuroScreen 这样的移动医疗工具可以很容易地进行修改，以用于其他疾病人群和世界上由于医疗资源非常有限而依赖任务转移的地区。