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和再住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)服务来连接更高级别的护理(即住院、部分住院、住院)和门诊护理之间的过渡，以减少复发和再入院。根据RFA-PA-09-164“NIH探索/发展研究资助计划(Parent R21)”的要求，该提案描述了基于iPhone的HIT服务IEAT的开发和可行性测试，IEAT：增强厌食症治疗的信息技术，该服务将作为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接触提供者的人数急剧减少，暴露在可能引发环境因素的环境中的机会增加。通过提供这种自我监测和沟通的桥梁，我们的目标是简化不同护理水平之间的过渡。IEAT将通过允许患者和提供者监控和管理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，从而增加每周的门诊治疗。我们将分3个阶段发展IEAT，每一步都有利益相关者(患者和提供者)参与。在第一阶段，我们将对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，我们将对4名患者和他们的提供者进行Beta测试。反馈将通知该应用程序的最终版本，然后将在阶段3对10名患者及其提供者进行非对照试验。患者将在出院前接受使用IEAT功能的iPhone的培训，提供者将通过iPhone或网络界面参与培训。患者将每天输入饮食交换、思想、情绪和限制和清除的冲动，以及从第一阶段和第二阶段测试中出现的其他变量。患者将收到基于他们的条目的自动反馈消息、当条目丢失时的提示、来自他们的提供者的预定的个性化反馈以及每周治疗团队关于实现治疗目标的进展的反馈。IEAT将允许患者和提供者查看他们每日条目的摘要以及在每周门诊期间收集的临床数据(例如，体重、自我报告测量)。在出院后四个月，IEAT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实用性和可接受性的报告进行评估。随后，IEAT将在随后的更大规模的随机对照试验中进行正式测试，以确定它是否增强了出院后对治疗目标的维护，并减少了再入院。IEAT有可能简化护理级别之间的过渡，并提供一种经济高效和用户友好的方法，以增加患者与提供者的联系，增强对症状的自我监控，并减少AN患者的再次住院。 公共卫生相关性：神经性厌食症(AN)的治疗费用昂贵，其特点是频繁复发和再次住院。IEAT有可能简化护理级别之间的过渡，并提供一种经济高效和用户友好的方法，以增加患者与提供者的联系，增强对症状的自我监控，并减少AN患者的再次住院。这里开发的技术将通过其他移动电话平台提供，并可随时进行修改，以管理其他精神和医疗状况。

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.