Exploratory Research Project - CAT

探索性研究项目 - CAT

• 批准号: 10577121
• 负责人: Rachel Elizabeth Davis-Martin
• 金额: $ 13.7万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-05 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10577121
• 关键词: Acceleration; Active Learning; Address; Administrator; Adoption; Adult; Ambulatory Care Facilities; Anxiety; Behavior; Caring; Cause of Death; Cellular Phone; Cessation of life; Clinic; Clinical; Collaborations; Communication Tools; Communities; Coupling; Data; Detection; Development; Economics; Electronic Health Record; Ensure; Environment; Ethics; Evidence based practice; Family; Feeling suicidal; Funding; Health Insurance Portability and Accountability Act; Healthcare; Hylobates Genus; Individual; Insurance Carriers; Intervention; Interview; Joints; Life Expectancy; Medical; Mental Depression; Mental Health; Mental Tests; Modality; Monitor; Morbidity - disease rate; National Institute of Mental Health; Pathway interactions; Patient Education; Patients; Persons; Point of Care Technology; Population; Primary Care; Privacy; Procedures; Provider; Public Health Informatics; Publishing; Recommendation; Research Personnel; Research Project Grants; Resources; Risk; Risk Factors; Sampling; Site; Specialist; Standardization; Substance abuse problem; Suicide; Suicide prevention; Symptoms; System; Tablets; Techniques; Technology; Test Result; Testing; Thinness; Time; Translating; Translations; United States; Update; Variant; Vendor; Visit; Work; base; behavioral health; clinical decision support; clinical decision-making; clinical practice; computerized; cost; dashboard; design; effective intervention; experience; feasibility testing; implementation measures; implementation science; implementation strategy; implementation trial; improved; informant; innovation; mortality; multidisciplinary; novel; patient health information; patient portal; prevent; primary care clinic; primary care practice; primary care provider; psychiatric symptom; screening; simulation; success; suicidal risk; translational barrier; trend; uptake; usability; user centered design; validation studies; visual tracking

CATS (EXPLORATORY PROJECT): ABSTRACT Significance: Approximately 45% of individuals who die by suicide had a visit with their primary care provider (PCP) in the month prior to their death and 77% in the year prior, making primary care clinics a crucial environment for identifying suicide risk. However, consistency and quality of screening for suicide risk in this setting vary widely by provider and clinic because of differences in providers’ comfort with assessing, discussing, and managing suicide, the need to consider broader symptoms and risks factors in addition to suicidal ideation, and the burden of competing medical demands and myriad mandated screenings. Computerized adaptive tests (CATs) have transformative potential for addressing these barriers and identifying and tracking mental health conditions, including suicide risk in primary care. Investigators: Our multi-disciplinary team comprised of specialists in suicide prevention and primary care (Davis-Martin, Mullin); EHR integration, health informatics and user-centered design (Tulu); user experience (Djamasbi); healthcare workflow redesign (Johnson); implementation science (Davis-Martin, Johnson); economics (Singh); privacy/ethics (Nebeker); and CATs (Gibbons) will work together to accomplish the Aims. Innovation: Using CATs to address initial detection, quantification, and longitudinal monitoring of suicide risk embedded in a range of mental health indicators in primary care is novel. We will create a package for downstream system-wide deployment for primary care clinics that enables easy patient access to complete CATs through multiple modalities and optimizes CATs results presentation for maximum clinical utility. Approach: We will study existing implementations of CAT-MHTM in three care settings, using key informant interviews with clinical administrators and providers, to identify variations in clinical workflows, barriers to deployment, and strategies for achieving effective EHR integration, HIPAA compliance, user acceptance, and clinical utility. We will integrate CAT-MHTM into the UMass EHR test environment, reflecting various workflows and result displays identified. A sample of primary care medical and behavioral health clinicians (n~10) will test alternatives, in the UMass iCELS, with standardized patients. We will capture CAT-MHTM result display utilization with eye tracking technology and identify strengths/weaknesses of designs using talk-through techniques. We will test the feasibility of deploying CAT-MHTM with clinicians and actual patients in one primary care clinic using the EPIS framework to guide implementation and a CQI approach to determine the best fitting clinical workflow. Implementation measures will include acceptability, usability, feasibility, reach, fidelity and simple costing. Environment: UMass, WPI, and ATT have successfully collaborated on numerous federally funded projects (R44MH118780, R44DA049448, NSF-IIS-1065298). Impact: This study will be used as pilot data for the subsequent implementation trial R01 that will study the implementation of the updated CAT-MHTM and workflows into the remaining primary care practices at UMass.

猫（探索项目）：摘要 重要性：大约45%的自杀死亡者与他们的初级保健提供者进行了访问 (PCP)在他们去世前的一个月和前一年的77%，使初级保健诊所成为至关重要的 识别自杀风险的环境。然而，在这方面，自杀风险筛查的一致性和质量 由于提供者对评估，讨论， 和管理自杀，需要考虑更广泛的症状和风险因素，除了自杀意念， 以及相互竞争的医疗需求和无数强制筛查的负担。计算机化自适应测验 （CAT）具有解决这些障碍以及识别和跟踪心理健康的变革潜力 包括初级保健中的自杀风险。 研究人员：我们的多学科团队由自杀预防和初级保健专家组成 （Davis-Martin，Mullin）; EHR整合、健康信息学和以用户为中心的设计（Tulu）;用户体验 （Djamasbi）;医疗保健工作流程重新设计（约翰逊）;实施科学（戴维斯-马丁，约翰逊）; 经济学（Singh）、隐私/伦理学（Nebeker）和CAT（Gibbons）将共同努力实现目标。 创新：使用CAT来解决自杀的初始检测，量化和纵向监测 初级保健中一系列心理健康指标所包含的风险是新的。我们将创建一个包， 为初级保健诊所提供下游全系统部署，使患者能够轻松获得完整的CAT 通过多种模式和优化CAT结果呈现，以实现最大的临床效用。 方法：我们将研究CAT-MHTM在三个护理环境中的现有实施情况，使用关键信息提供者， 与临床管理人员和提供者进行访谈，以确定临床工作流程中的变化， 部署，以及实现有效的EHR集成、HIPAA合规性、用户接受度和 临床应用我们将CAT-MHTM集成到马萨诸塞大学EHR测试环境中，反映各种工作流程 并识别结果显示。一个样本的初级保健医疗和行为健康临床医生（n~10）将测试 替代方案，在马萨诸塞大学iCELS，与标准化的患者。我们将捕获CAT-MHTM结果显示利用率 使用眼动追踪技术，并使用交谈技术识别设计的优点/缺点。我们 将测试在一个初级保健诊所与临床医生和实际患者一起部署CAT-MHTM的可行性， EPIS框架用于指导实施，CQI方法用于确定最适合的临床工作流程。 执行措施将包括可接受性、可用性、可行性、覆盖面、忠实性和简单成本计算。 环境：马萨诸塞大学，WPI和ATT成功地合作了许多联邦资助的项目 （R44MH118780、R44DA049448、NSF-IIS-1065298）。 影响：本研究将用作后续实施试验R 01的试点数据，该试验将研究 更新的CAT-MHTM和工作流程的实施到马萨诸塞州大学其余的初级保健实践。