iEAT: Information Technology to Enhance Anorexia Treatment

描述（由申请人提供）：神经性厌食症（AN）在医院治疗后的复发率和再入院率高得令人无法接受，给患者和家庭成员带来了重大的经济、心理和社会负担。我们建议应用健康信息技术（HIT）服务，在较高水平的护理（即住院、部分住院、住院）和门诊护理之间架起桥梁，以减少复发和再入院。该提案响应RFA-PA-09-164“NIH探索性/发展性研究资助计划（家长R21）”，描述了基于iphone的HIT服务的开发和可行性测试，iEAT：信息技术增强厌食症治疗，将作为an患者及其提供者的自我监测和沟通工具。向门诊护理过渡的标志是与医疗服务提供者的接触急剧减少，暴露于潜在触发环境因素的机会增加。通过提供这种自我监控和沟通的桥梁，我们的目标是缓解护理水平之间的过渡。iEAT将通过允许患者和提供者监测和管理an相关症状和行为，从而增加和改善患者的自我护理和与提供者的沟通，从而增加每周门诊治疗。我们将分三个阶段发展IEAT，每个阶段涉及利益相关者（患者和提供者）。在第一阶段，我们将与患者和提供者进行深入访谈，以充分了解需求并发展iEAT。在第二阶段，我们将在4名患者和他们的医生中进行测试。反馈信息将为应用程序的最终版本提供信息，该应用程序将在第三阶段的无控制试验中对10名患者及其提供者进行测试。患者将在出院前接受使用iEAT的iPhone的培训，医疗服务提供者将通过iPhone或网络界面参与。患者将每天输入饮食交流、思想、情绪、限制和净化的冲动，以及第一阶段和第二阶段测试中出现的其他变量。患者将根据他们的记录收到自动反馈信息，当条目遗漏时提示，他们的提供者安排的个性化反馈，以及每周治疗团队关于治疗目标进展的反馈。iEAT将允许患者和提供者查看他们的每日条目摘要以及每周门诊访问期间收集的临床数据（例如，体重，自我报告测量）。出院后4个月，将根据条目的有效性、依从性、数据条目的频率和质量，以及患者和提供者关于其效用和可接受性的报告，对iEAT进行评估。iEAT将在随后的一项更大的随机对照试验中进行正式测试，以确定它是否能提高出院后治疗目标的维持并减少再入院率。iEAT有可能缓解不同护理水平之间的过渡，并提供一种具有成本效益和用户友好的方法，以增加患者与提供者的接触，加强症状的自我监测，并减少AN患者的再入院率。

DESCRIPTION (provided by applicant): Relapse and readmission rates after hospital-based treatment of anorexia nervosa (AN) are unacceptably high, placing a major financial, psychological, and social burden on patients and family members. We propose the application of a Health Information Technology (HIT) service to bridge the transition between higher levels of care (i.e., inpatient, partial hospitalization, residential) and outpatient care with the goal of reducing relapse and readmission. This proposal in response to RFA-PA-09-164 "NIH Exploratory/Developmental Research Grant Program (Parent R21)", describes the development and feasibility testing of an iPhone-based HIT service, iEAT: Information Technology to Enhance Anorexia Treatment, that will serve as a self-monitoring and communication tool for patients with AN and their providers. The transition to outpatient care is marked by a dramatic decrease in provider contact and increased exposure to potentially triggering environmental factors. By providing this self-monitoring and communication bridge, we aim to ease the transition between levels of care. iEAT will augment weekly outpatient treatment by allowing patients and providers to monitor and manage AN-related symptoms and behaviors thereby increasing and improving patient self-care and communication with their providers. We will develop IEAT in 3 stages involving stakeholders (patients and providers) at each step. In Stage 1, we will conduct in-depth interviews with patients and providers to fully understand needs and develop iEAT. In Stage 2, we will beta-test the program with 4 patients and their providers. Feedback will inform the final version of the application which will then be tested in Stage 3 in an uncontrolled trial of 10 patients and their providers. Patients will be trained in the use of the iEAT enabled iPhones prior to hospital discharge and providers will participate via iPhone or web interface. Patients will input daily entries of dietary exchanges, thoughts, mood, and urges to restrict and purge, as well as other variables that emerge from Stage 1 and 2 testing. Patients will receive automated feedback messages based on their entries, prompts when entries are missed, scheduled individualized feedback from their provider, and weekly treatment team feedback regarding progress towards treatment goals. iEAT will allow patients and providers to view summaries of their daily entries as well as clinical data collected during weekly outpatient visits (e.g., weight, self-report measures). At four months post-discharge, iEAT will be evaluated based on validity of entries, adherence, frequency and quality of the data entries over time, as well as patient and provider reports on its utility and acceptability. iEAT will then be tested formally in a subsequent larger randomized controlled trial to determine whether it enhances post-discharge maintenance of treatment goals and decreases readmission. iEAT has the potential to ease the transition between levels of care and provide a cost-effective and user- friendly approach to increase patient-provider contact, enhance self-monitoring of symptoms, and decrease hospital readmission for individuals with AN. PUBLIC HEALTH RELEVANCE: Treatment for anorexia nervosa (AN) is expensive and is marked by frequent relapse and re-hospitalization. iEAT has the potential to ease the transition between levels of care and provide a cost-effective and user- friendly approach to increase patient-provider contact, enhance self-monitoring of symptoms, and decrease hospital readmission for individuals with AN. The technology developed here will be made available through other mobile phone platforms and readily modifiable for management of other psychiatric and medical conditions.