A cloud-based digital health navigation program for colorectal cancer screening

超过30%的符合年龄条件的美国人没有接受结直肠癌(CRC)的推荐筛查， 美国癌症死亡的第二大原因。多层壁垒解释了为什么这么多美国人 未能接受常规的CRC筛查。患者报告缺乏对筛查必要性的了解或他们的 筛查选项，许多人认为筛查是混乱、不舒服或尴尬的。忙碌的临床医生报告 缺乏提供预防性护理的时间，许多临床医生只讨论结肠镜检查。最后，医疗保健 系统缺乏独立于预定医疗访问接触患者的策略。造成的中断 COVID19还导致预防性服务的使用减少。要解决这些多层次的问题 障碍，我们的团队已经开发并测试了一种基于平板电脑的结直肠癌数字健康导航器 筛查被称为mPATH™(移动患者健康技术)。MPATH™确定患者是否到期 对于CRC筛查，让他们了解自己的选择，并让他们直接通过 程序。在一项在初级保健实践中进行的随机对照试验中，mPATH™将 完成CRC筛查并具有优秀可用性评级的患者比例。然而，我们有 了解到我们的基于平板电脑的mPATH™模型很难扩展，因为它需要现场培训和更改 到工作流。此Fast Track STTR计划的目标是开发和测试基于云的版本 MPATH™，患者可以在家中使用，而不需要定期就医。患者将访问 在他们自己的设备上使用通过文本消息或患者门户发送的超链接进行™。云版本的 MPATH™将拥有经过验证的平板电脑版本的有效内容，包括请求 直接通过程序进行筛选测试。然后，MPATH™将与患者的医疗保健共享此信息 组织，以便可以安排筛查。这个基于云的版本将高度可扩展，具有广泛的 覆盖范围广，易于支持，使其成为商业上可行的产品。为实现这一目标， 该提案将：(1)通过以下方式创建符合文化要求且引人入胜的基于云的mPATH™版本 利用社区成员、专家科学咨询委员会和用户的反馈意见； (2)在高度务实的中试中确定基于云的mPATH™-CRC网络应用程序的可行性 在大型医疗系统中进行；(3)分两个阶段测试mPATH™Web应用程序的覆盖范围和有效性 不同的医疗保健环境：大型医疗系统和包括农村地区在内的责任关怀组织 联邦合格的健康中心；以及(4)确定mPATH™在每个医疗保健中产生的价值 布景。这份快速跟踪技术报告将提供对mPATH™的S未来商业化至关重要的信息 展示了它对不同人群的影响，在增加筛查方面的有效性，以及它的价值 为潜在的未来客户创造机会。如果成功，mPATH™将满足商业上对 提供易于扩展的解决方案，用于结直肠癌筛查和潜在的其他预防服务。

Over 30% of age-eligible Americans fail to receive recommended screening for colorectal cancer (CRC), the second leading cause of cancer death in the United States. Multilevel barriers explain why so many Americans fail to receive routine CRC screening. Patients report a lack of knowledge about the need for screening or their screening options, and many view screening as messy, uncomfortable, or embarrassing. Busy clinicians report a lack of time to deliver preventive care, and many clinicians only discuss colonoscopy. Lastly, healthcare systems lack strategies to reach out to patients independent of a scheduled medical visit. Disruptions caused by COVID19 also have led to a decrease in the use of preventive services. To address these multilevel barriers, our team has developed and tested a tablet-based digital health navigator for colorectal cancer screening called mPATH™ (mobile Patient Technology for Health). mPATH™ determines if patients are due for CRC screening, educates them about their options, and lets them request a screening test directly via the program. In a randomized controlled trial conducted in primary care practices, mPATH™ doubled the proportion of patients who completed CRC screening and had excellent usability ratings. However, we have learned that our tablet-based model of mPATH™ is difficult to scale as it requires on-site training and changes to workflows. The goal of this Fast Track STTR proposal is to develop and test a cloud-based version of mPATH™ that patients can use at home independent of a scheduled medical visit. Patients will access mPATH™ on their own devices using a hyperlink sent via text message or patient portal. The cloud version of mPATH™ will have the proven effective content of the tablet version, including the ability to request a screening test directly via the program. mPATH™ will then share this information with the patient’s healthcare organization so screening can be arranged. This cloud-based version will be highly scalable, have broad reach, and be easy to support, making it a commercially viable product. To accomplish this goal, the work of this proposal will: (1) create a culturally appropriate and engaging cloud-based version of mPATH™ by leveraging input from community members, an expert Scientific Advisory Committee, and feedback from users; (2) determine the feasibility of the cloud-based mPATH™-CRC web app in a highly pragmatic pilot trial conducted in a large health system; (3) test the reach and effectiveness of the mPATH™ web app in two different healthcare settings: a large health system, and an Accountable Care Organization that includes rural Federally Qualified Health Centers; and (4) determine the value generated by mPATH™ in each healthcare setting. This Fast Track STTR will provide information that is critical to mPATH™’s future commercialization by demonstrating its reach into diverse populations, its effectiveness in increasing screening, and the value it generates to potential future customers. If successful, mPATH™ will fill a critical need for a commercially available, easily scalable solution for colorectal cancer screening and potentially other preventive services.