Improving Adolescent Sexual Health Outcomes using Health Information Technology

项目摘要 青少年占每年新增的性传播感染(STI)病例的近一半， 非西班牙裔黑人和西班牙裔青年受到的影响不成比例。这些差异在一定程度上是由于 有区别地获得和常规使用优质卫生保健，包括性传播感染的预防和治疗。这个 我们研究工作的首要目标是改善青少年的性健康结果，并减轻 通过利用急诊科(ED)的卫生信息技术(HIT)来实现STI比率的差异 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实现以下目标，扩展和优化我们提高STI检测率的成功流程：1) 通过提供实时的电子健康记录，集成大规模的针对性性传播感染筛查 将基于患者报告性传播感染风险评估的临床决策支持(CDS)嵌入到正常边缘 改善STI检测的工作流程和2)使用移动医疗(MHealth)来提高STI治疗率。建房 在前期工作中，我们的具体目标是：1)使用人因工程的方法来实施 并将大规模计算机辅助的性传播感染筛查过程优化到急诊室的临床工作流程中；2) 比较性健康筛查(SHS)衍生的电子CDS中性传播感染检测率的差异 策略与常规护理(不提供CDS)；以及3)比较治疗依从性方面的差异 接受短信的患者与接受常规护理(没有短信)的患者相比。在第一个目标内，我们 将使用人为因素工程学方法进行工作流分析，这将为改进提供信息 在急诊室的临床工作流程中实施性传播感染筛查程序。在第二个目标中，我们将 使用中断的时间序列设计进行务实试验，以衡量SHS衍生的影响 关于性传播感染检测率的电子CDS。在第三个目标中，我们将进行随机临床试验，嵌套在 这项务实的试验，旨在衡量双向短信干预对提高治疗率的影响 通过识别和解决STI治疗依从性的障碍。这种创新方法充分利用了 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，并减少 通过增加性传播感染的检测和监测，在高危、易感青少年中的性传播感染负担方面的差异 治疗依从性。这项拟议的工作意义重大，因为它有可能改善 数以百万计的青少年将急救作为其唯一的医疗保健来源，并影响相关的国家政策 性传播感染的检测和治疗。此外，这项工作还可以为利用HIT交付提供概念验证 以患者为中心的护理和共享决策，以解决医疗保健差距和改善医疗保健 质量和结果，这可以在未来应用于其他类型的筛查干预。

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.