Scaling a smarter and more efficient intervention: Evaluating the feasibility of disseminating a novel mobile app platform to treat depression

摘要 这个项目的目标是进行一项试点研究，以测试自然语言处理(NLP)的效用 临床消息传递工具，可提高教练的覆盖面和质量(保真度和能力) 通过一款名为Personalized Real-Time的移动心理健康应用实现行为激活(BA)策略 激励增强干预(PRIME)。尽管几十年来对 在情绪障碍的治疗方面，抑郁症已从第五大致残原因上升为第一大致残原因 在美国。在这一领域取得进展的关键障碍是：1)消费者难以获得高质量的医疗服务；2) 精神卫生工作人员有限；以及3)很少有提供者接受过循证培训 治疗。针对这一公共卫生问题，我们团队提出利用移动平台 改善循证治疗的可获得性；增加心理健康教练的覆盖面，同时支持 提供更高质量的护理。我们将通过使用NLP驱动的 消息传递工具，它将确保BA模型的保真度，临床医生将能够访问实时临床 关于他们病人的信息以指导更有针对性的治疗(能力)。通过提高效率 在流动精神卫生服务的背景下，我们期望患者 在抑郁、情绪相关的残疾和实现个人目标方面取得更大的进步。为了 评估Prime增强功能的可行性、容忍性和总体影响，我们将在第1年花时间 让利益相关者参与以人为中心的迭代设计过程，并花费2-3年时间进行试点 随机对照试验中，我们将随机选择120名抑郁症患者，接受8- 1)Prime 1.0(当前版本)或2)Prime 2.0(NLP支持的临床医生的版本 仪表板)。使用我们的移动临床试验平台Bright ten，我们将招募参与者，同意，筛选， 完全远程评估和提供干预。这项研究的试点数据将用于为 一项R01研究，确定Prime是否可以用于高效和有效地改进 明显更多的抑郁症患者的结果。

ABSTRACT The goal of this project is to conduct a pilot study to test the utility of a Natural Language Processing (NLP) clinical messaging tool to improve the reach and the quality (fidelity and competency) of coaches providing behavioral activation (BA) strategies through a mobile mental health app called Personalized Real-time Intervention for Motivational Enhancement (PRIME). Despite decades of research and development for the treatment of mood disorders, depression has risen from the 5th leading cause of disability to the leading cause in the US. Critical barriers for progress in the field are 1) Poor access to high quality care for consumers; 2) Limited mental health workforce; and 3) Few providers are trained in the delivery of evidence-based treatments. In response to this public health problem, our team is proposing to use a mobile platform to improve access to an evidence based treatment; increase the reach of mental health coaches while supporting the delivery of higher quality of care. We will improve the reach of clinicians by using a NLP-powered messaging tool, which will ensure fidelity to the BA model and clinicians will have access to real-time clinical information about their patients to guide more targeted treatment (competence). By improving the efficiency and competence of mental health coaches in the context of mobile mental health services, we expect patients to make greater gains in depression, mood-related disability, and in achieving personal goals. In order to evaluate the feasibility, tolerability, and overall impact of the enhancements to PRIME, we will spend Year 1 engaging stakeholders in a human centered iterative design process and spend Years 2-3 conducting a pilot randomized controlled trial in which we will randomize 120 individuals with depression to either receive 8- weeks of 1) PRIME 1.0 (current version) OR 2) PRIME 2.0 (version with the NLP-powered clinician dashboard). Using BRIGHTEN, our mobile clinical trial platform, we will recruit participants, consent, screen, evaluate and deliver the intervention entirely remotely. The pilot data from this study will be used to prepare for a R01 study to definitively determine whether PRIME may be used to efficiently and effectively improve outcomes for a significantly larger number of individuals with depression.