Improving Teen Care with HIT

描述（由申请人提供）：青少年发病和死亡的大多数原因是参与健康风险行为，如酒精和其他药物使用，吸烟，没有使用避孕或性传播疾病保护的性活动，以及不健康的饮食模式和缺乏身体活动。这些行为通常在青春期开始，然后持续到成年，从而也影响成人健康，疾病，残疾，医疗保健负担和过早死亡。认识到这些行为对青少年和成人健康的影响，来自多个组织的专业实践指南建议初级保健提供者筛查这些行为，并提供旨在预防和降低风险的咨询。尽管有这些建议，而且每年有超过70%的青少年接受初级保健治疗，但初级保健环境中对有健康风险行为的青少年的识别不足，而且很少提供降低风险咨询或后续干预措施来降低风险。为了解决这一差距，在推荐的护理，我们建议开发和测试一个基于网络的互动健康评估（iHA）的实施在初级保健设置之前，青少年的医疗保健访问。iHA旨在：1）进行多风险筛查; 2）提供个性化的以青年为重点的预防和降低风险的反馈; 3）总结结果，除了青年报告的风险行为，目标，以及初级保健提供者（PCP）的后果，以刺激患者-提供者的讨论;以及4）为PCP提供决策支持，以确定下一步适当的护理步骤。个性化反馈（上述第2部分）是这项拟议干预措施的一个创新特征，因为它在减少年轻人危险饮酒方面表现出了强大的有效性，但尚未在青少年中进行测试，也没有外推到医疗保健环境中物质使用以外的健康行为。iHA涵盖的健康领域包括酒精、烟草和药物使用;体育活动;饮食;性健康;以及安全。这项拟议的研究将从6个初级保健诊所招募13-18岁的青少年样本。在第一阶段，我们将根据青少年和初级保健提供者的正式可用性测试优化iHA设计和内容，并将制定实施流程和培训材料，以促进iHA在初级保健环境中的无缝整合。在第2阶段，我们对300名青少年进行了一项随机对照试验，以检查这种iHA在医疗保健访视期间增加预防和降低风险咨询的有效性，以及在1个月和6个月随访时减少各种青少年健康风险行为的有效性。

DESCRIPTION (provided by applicant): Most of the causes of adolescent morbidity and mortality result from participation in health risk behaviors, such as alcohol and other drug use, smoking, sexual activity without use of protection against pregnancy or sexually transmitted diseases, and unhealthy eating patterns and physical inactivity. These behaviors frequently begin during adolescence and then persist into adulthood, thereby also influencing adult health, disease, disability, healthcare burden, and premature death. In recognition of the impact of these behaviors on adolescent and adult health, professional practice guidelines from multiple organizations recommend that Primary Care Providers screen for these behaviors and provide counseling aimed at prevention and risk reduction. Despite these recommendations and the fact that over 70% of adolescents are seen in primary care each year, adolescents with health risk behaviors are underidentified in primary care settings, and are seldom provided with risk reduction counseling or follow up interventions to decrease their risks. To address this gap in recommended care, we propose to develop and test a web-based interactive Health Assessment (iHA) for implementation in primary care settings prior to adolescent healthcare visits. The iHA is designed to: 1) conduct multi-risk screening; 2) provide personalized youth-focused prevention and risk reduction feedback; 3) summarize results, in addition to youth-reported risk behaviors, goals, and consequences for Primary Care Providers (PCPs) in order to stimulate patient-provider discussions; and 4) provide decision support for PCPs in determining the next appropriate steps in care. Personalized feedback (component #2 above) is an innovative feature of this proposed intervention, as it has demonstrated robust effectiveness in reducing risky drinking among young adults, but has not yet been tested with adolescents, nor extrapolated to health behaviors beyond substance use in healthcare settings. Health areas covered by the iHA include alcohol, tobacco and drug use; physical activity; diet; sexual health; and safety. The proposed study will recruit a sample of adolescents aged 13-18 from six primary care clinics. In Phase 1, we will optimize the iHA design and content based on formal usability testing with adolescents and primary care providers, and will develop implementation processes and training materials to promote seamless integration of iHA in primary care settings. In Phase 2, we conduct a randomized, controlled trial with 300 adolescents to examine the efficacy of this iHA on increasing the provision of prevention and risk reduction counseling during the healthcare visit, and on reducing a variety of adolescent health risk behaviors at 1 and 6 month follow ups, relative to usual care.