Improving Adolescent Sexual Health Outcomes using Health Information Technology

项目摘要 青少年占每年所有新的性传播感染病例的近一半，其中， 非西班牙裔黑人和西班牙裔青年受到的影响尤为严重。这些差异部分归因于， 在获得和例行使用优质保健服务方面，包括性传播感染的预防和治疗方面，存在差别。的 我们研究工作的总体目标是改善青少年性健康结果， 通过在急诊科（艾德）利用卫生信息技术（HIT）， 通过共同决策实现性传播感染的检测和治疗。这项建议的目的是 通过利用HIT来扩展和优化我们在提高STI测试率方面的成功流程：1）无缝 通过提供实时电子健康记录，整合大规模有针对性的性传播感染筛查 基于患者报告的STI风险评估的嵌入式临床决策支持（CDS）进入正常艾德 2）使用移动的健康（mHealth）来提高性传播感染的治疗率。建筑 在我们的前期工作中，具体的目标是：1）使用人因工程的方法来实现 并优化大规模的计算机辅助STI筛查过程，将其纳入艾德的临床工作流程; 2） 比较性健康筛查（SHS）衍生的电子CDS之间STI检测率的差异 策略与常规护理（不提供CDS）;以及3）比较 接受短信的患者与接受常规护理（无短信）的患者。在第一个目标中，我们 将使用人因工程方法进行工作流程分析，这将为改进提供信息 在急症室的临床工作流程中推行性病检查程序。在第二个目标方面，我们会 使用中断的时间序列设计进行务实的试验，以衡量SHS衍生的影响 性传播感染检测率的电子CDS。在第三个目标中，我们将进行一项随机临床试验， 务实的试验，以衡量双向短信干预的影响，以提高治疗率 通过识别和解决坚持性传播感染治疗的障碍。这种创新方法利用了 HIT以电子方式整合患者报告的性风险数据，以指导CDS和mHealth改善 治疗依从性。我们希望我们的贡献有助于改善性健康结果， 通过增加性传播感染的发现，在高危、弱势青少年中减少性传播感染的负担， 治疗依从性。拟议的工作是重要的，因为它有可能改善健康的 数百万青少年将ED作为他们唯一的医疗保健来源，并影响国家相关政策 性传播感染的检测和治疗。此外，这项工作可以为利用HIT提供概念验证， 以患者为中心的护理，共同决策，以解决医疗保健差异并改善医疗保健 质量和结果，未来可以应用于其他类型的筛查干预措施。

Project Abstract Adolescents account for nearly half of all new sexually transmitted infection (STI) cases annually, and of those, non-Hispanic Black and Hispanic youth are disproportionately affected. These disparities are attributed, in part, to differential access to and routine use of quality health care, including STI prevention and treatment. The overarching goal of our research efforts are to improve adolescent sexual health outcomes and mitigate disparities in STI rates by leveraging health information technology (HIT) in the emergency department (ED) to enable detection and treatment of STIs through shared decision making. The objective of this proposal is to scale and optimize our successful process in improving STI testing rates by leveraging HIT to: 1) seamlessly integrate broad-scale targeted STI screening through the provision of real-time, electronic health record embedded, clinical decision support (CDS) based on patient-reported STI-risk assessment into the normal ED workflow to improve STI detection and 2) use mobile Health (mHealth) to improve STI treatment rates. Building on our preliminary work, the specific aims are to: 1) use a human factors engineering approach to implement and optimize a broad-scale computer-facilitated STI screening process into the clinical workflow of the ED; 2) compare differences in STI detection rates between a sexual health screening (SHS)-derived electronic CDS strategy versus usual care (no provision of CDS); and 3) compare differences in treatment adherence between patients receiving text messages versus those receiving usual care (no text messages). Within the first aim, we will use a human factors engineering approach to conduct workflow analyses which will inform the refinement of implementation of an STI screening process into the clinical workflow of the ED. In the second aim, we will conduct a pragmatic trial using an interrupted time series design to measure the impact of SHS-derived electronic CDS on STI detection rates. In the third aim, we will conduct a randomized clinical trial, nested within the pragmatic trial, to measure the impact of a two-way text-messaging intervention to improve treatment rates through identifying and addressing barriers to STI treatment adherence. This innovative approach leverages HIT to electronically integrate patient-reported sexual risk data to guide CDS and mHealth to improve treatment adherence. We expect our contribution to help improve sexual health outcomes and reduce disparities in the burden of STIs among at-risk, vulnerable adolescents by increasing STI detection and treatment adherence. The proposed work is significant because it has the potential to improve the health of the millions of adolescents who access EDs as their only source of healthcare and impact national policies related to STI detection and treatment. In addition, this work can provide proof of concept for leveraging HIT to deliver patient-centered care with shared decision making to address health care disparities and improve healthcare quality and outcomes, which can be applied to other types of screening interventions in the future.