Patient-facing decision support for HIV and sexually transmitted infection prevention in low-income and minority patient populations.

项目概述：该项目的总体目标是为杰克曼博士提供丰富的培训计划 这足以让他做好准备，成为一名专注于发展和 实施数字保健干预措施，以解决小规模人口之间的健康差距。 美国的性传播感染(STI)发病率创历史新高， 性传播感染、人类免疫缺陷病毒(HIV)感染和后遗症之间的持续差异 青少年和青壮年(Aya)、低收入和黑人/非裔美国人群体。严重不良反应 性传播感染对健康的影响，包括盆腔炎、宫外孕、 据估计，每年有2万名美国女性患有先天性梅毒、艾滋病毒和不孕不育。以患者为中心的临床 决策支持(PC CDS)是使用的个性化、以患者为中心、面向患者的数字医疗保健应用程序 在两次健康检查之间提供病人护理。这项拟议的计划将利用电子健康记录 (EHR)新型PC CDS干预中的患者门户，以优化性健康决策，伴侣 马里兰州巴尔的摩15至25岁的Aya之间的沟通和对临床服务的接受。初步 研究表明，基于EHR患者门户的干预措施有望帮助年轻人克服障碍 例如，有限的性传播感染/艾滋病毒检测和治疗机会，往往导致不披露、披露 不准确，以及获得与性传播感染/艾滋病毒有关的高质量和准确的信息和资源。最近， 《21世纪治疗法案最终规则》、《国家艾滋病毒/艾滋病战略》和《全国性传播感染》中包含的语言 战略计划将患者门户作为提高患者医疗参与度的关键工具。然而， 自新冠肺炎大流行以来，随着对患者门户和远程医疗服务的依赖增加，情况也是如此 社会经济条件不佳的青年在医疗保健方面长期存在不平等的风险。然而， 使用放大独特声音的范式设计的干预措施相当缺乏 小型化Aya最终用户的体验，以满足他们的医疗服务需求和偏好 通过患者门户网站预防STI/HIV。这个辅导式研究职业发展奖是为 提供必要的培训，以便在数字医疗研究中脱颖而出，重点是缩小健康差距 并为公共卫生信息学科学做出贡献。研究的目的是：(A)描述纵向 大型学术健康人群中城市Aya患者使用EHR患者门户的模式和相关性 系统；(B)使用设计思维程序，制定个人疾病预防和预防干预措施，以支持性病/艾滋病毒的传播 通过EHR患者门户网站在城市Aya患者中提供预防服务和行为，以及(C)开展3- 一个月的试点研究，以确定干预的可行性和可接受性。这项研究将提供至关重要的 初步数据为R01资助的随机试验的设计提供信息，以确定 新的PC CDS干预措施，以优化患者门户参与并降低城市Aya中的STI/HIV风险。

Project Summary: The overarching goal of this project is to provide Dr. Jackman with a rich training program that adequately prepares him to become an independent investigator focused on the development and implementation of digital healthcare interventions to address health disparities among minoritized populations. The United States has experienced record-breaking highs in sexually transmitted infection (STI) incidence and persistent disparities in STIs and human immunodeficiency virus (HIV) infections and sequelae among adolescent and young adult (AYA), low income, and Black/African-American populations. Serious adverse health consequences are attributable to STIs, including pelvic inflammatory disease, ectopic pregnancy, congenital syphilis, HIV, and infertility in an estimated 20,000 U.S. women annually. Patient centered clinical decision support (PC CDS) are personalized, patient-centric, patient-facing digital healthcare applications used to deliver patient care between health visits. This proposed program will leverage the electronic health record (EHR) patient portal in a novel PC CDS intervention to optimize sexual health decision making, partner communication, and uptake of clinical services among AYA aged 15 to 25 years in Baltimore, MD. Preliminary studies demonstrate the promise of EHR patient portal-based interventions to help youth overcome barriers such as, limited STI/HIV testing and treatment access, the stigma that often leads to non-disclosure, disclosure inaccuracies, and access to high quality and accurate STI/HIV-related information and resources. Recently, language included in the 21st Century Cures Act Final Rule, National HIV/AIDS Strategy, and STI National Strategic Plan bolsters patient portals as a critical tool for improving patient healthcare engagement. However, as reliance on patient portals and telehealth services have increased since the COVID-19 pandemic, so does the risk of perpetuating inequities in healthcare access among socioeconomically underserved youth. Yet, there is a considerable lack of interventions designed using a paradigm that amplifies the unique voices and experiences of minoritized AYA end-users to meet their healthcare engagement needs and preferences for STI/HIV prevention through the patient portal. This mentored research career development award is designed to provide the necessary training to excel in digital healthcare research focused on reducing health disparities and contribute to the public health informatics sciences. Research aims are to: (a) Describe longitudinal patterns and correlates of EHR patient portal use among urban AYA patients in a large academic health system; (b) Use a design thinking process to develop a PC CDS intervention to support the uptake of STI/HIV prevention services and behaviors among urban AYA patients via the EHR patient portal, and (c) Conduct a 3- month pilot study to determine feasibility and acceptability of the intervention. This study will provide crucial preliminary data to inform the design of an R01-funded randomized trial to determine the effectiveness of a novel PC CDS intervention to optimize patient portal engagement and reduce STI/HIV risk among urban AYA.