Validation of the TAPS-Electronic Spanish Platform (TAPS-ESP): A Technology to Improve Access to Substance Use Screening and Reduce Behavioral Health Disparities in Hispanic Primary Care Patients

摘要 语言可及性和文化意识是优质医疗的基本要素。人士 有限的英语水平不太可能自我确定需要行为健康服务，这导致 未治疗疾病的持续时间较长。准确的识别、诊断和治疗完全依赖于 在语言上准确的筛选和评估，特别是对敏感的话题，如药物使用。 初级保健中的物质使用筛查现在被推荐为所有成年人的循证实践， 但仍然未得到充分利用。现有物质使用筛查工具的缺点导致NIH开发了 并验证“烟草、酒精、处方药和非法物质使用工具（TAPS工具）， 筛查和简要评估工具，以发现初级保健中的物质使用问题。作为第一阶段的一部分， 在NIMHD STTR项目中，我们的团队领导了一项研究驱动的TAPS工具到西班牙语的改编 版本，并开发了移动的/平板电脑技术平台，以支持其在医疗保健环境中的部署 (the TAPS-Electronic Spanish Platform，或TAPS-ESP）。 目前的第二阶段SBIR研究建立在这一努力的基础上。对于目标1，我们将TAPS-ESP集成到 Baylor Scott和白色健康（BSWH）的现有卫生信息技术基础设施， 德克萨斯州的医疗保健系统为大量讲西班牙语的患者提供服务。目标2： 针对广泛使用的诊断参考标准进行TAPS-ESP的大规模验证研究， 其他筛查工具，以及在1 000名讲西班牙语的小学生中进行口腔液/唾液药物测试 照顾病人。另外，对于目标3，我们将进行一项现实世界的实施试验，其中10个初级保健 提供者接受关于TAPS-ESP的培训，将其纳入标准护理，并完成定性评估。 从供应商工作流程的角度对实施的障碍和促进因素进行访谈。 据我们所知，这将是西班牙语物质使用的最大验证研究 在美国的筛选工具。该项目可以扩大获得基于证据的，语言准确的 物质使用筛查和简要评估的服务不足的人口，经历了重大 行为健康差异。因此，该项目可能具有很高的科学和公共卫生影响，沿着 强大的商业化潜力。

ABSTRACT Language accessibility and cultural awareness are essential elements of quality healthcare. Individuals with limited English proficiency are less likely to self-identify a need for behavioral health services, which results in longer duration of untreated disorders. Accurate identification, diagnosis, and treatment are entirely dependent on a linguistically-accurate screening and assessment, especially for sensitive topics such as substance use. Substance use screening in primary care is now recommended as an evidence-based practice for all adults, but remains underutilized. The shortcomings of existing substance use screening tools led the NIH to develop and validate the “Tobacco, Alcohol, Prescription drug, and illicit Substance use Tool (TAPS Tool), a two-stage screening and brief assessment tool to detect substance use problems in primary care. As part of our Phase I NIMHD STTR project, our team led a research-driven adaptation of the TAPS Tool into a Spanish language version, and developed a mobile/tablet technology platform to support its deployment in healthcare settings (the TAPS-Electronic Spanish Platform, or TAPS-ESP). The current Phase II SBIR study builds on this effort. For Aim 1, we will integrate the TAPS-ESP into the existing health information technology infrastructure of Baylor Scott and White Health (BSWH), a large healthcare system in Texas that serves a large number of Spanish-speaking patients. For Aim 2, we will conduct a large-scale validation study of the TAPS-ESP against a widely-used diagnostic reference standard, other screening tools, and oral fluid/saliva drug testing in a large sample of 1,000 Spanish-speaking primary care patients. Separately, for Aim 3 we will conduct a real-world implementation trial in which 10 primary care providers receive training on the TAPS-ESP, incorporate it into standard care, and complete a qualitative interview on barriers and facilitators of implementation from a provider workflow perspective. To the best of our knowledge, this will be the largest validation study of a Spanish-language substance use screening tool in the US to date. The project could expand access to evidence-based, linguistically-accurate substance use screening and brief assessment for an underserved population that experiences significant behavioral health disparities. Thus, the project could have high scientific and public health impact, along with strong commercialization potential.