Translating Scientific Evidence into Practice using Digital Medicine and Electronic Patient Reported Outcomes

项目摘要： 传统上，医疗保健的提供仅限于亲自到办公室就诊或住院， 而患者大部分时间都在家里或工作。数字医学（例如应用程序， 远程监控，远程医疗，患者报告的结果 [ePRO]）有可能弥合这一差距，但目前还不清楚如何在主流中实施 临床实践，可以导致高水平的患者和提供者采用。通过建立 炎症性肠病（IBD）的数字化转型网络（DTN），我们计划 缩小数字差距，科学解决数字健康的证据缺口 在人群和社区中进行干预。 AIM岛统一现有数字资产（移动的应用程序、ePRO、数字差异评估， 行为健康，转诊到IBD家庭和健康教育）到IBD数字治疗 在3个CTSA中心提供工具包并与EHR集成。假设：与EHR集成将导致 提供商采用率更高，并限制工作流程中断。 目标二：建立数字连接、疾病控制、生活质量和护理的基线水平 三个IBD中心的队列指标。假设：多管齐下的方法 通过文本、电话、应用程序和亲自进行评估将获得更高的采用率。 AIM III.实施和评估精确匹配的干预措施（数字技能、社交 决定因素，行为健康，通过应用程序进行监测，以及转诊 跨学科护理）在1500例IBD患者中使用阶梯楔形，群集- 随机试验假设：由统一平台支持的医疗之家将转化为 人口健康成果的可持续改善。分析DTN的影响 干预措施。主要结局将是患者百分比的改善， DTN在疾病控制和减少紧急护理利用（急诊科就诊 和住院天数）。 AIM IV.支持跨CTSA站点的可持续性和传播。假设：患者- 通过与基于价值的医疗保健保持一致，以DTN为中心的DTN将是可持续的。 预期影响：约有200万美国人患有IBD，更多的人患有慢性炎症。 炎症性疾病。我们希望这项研究能帮助我们建立一个基于证据的方法 以确定数字医学是否可以吸引不同的患者群体， 如果是，如何在不同的环境中复制和推广， 解决T3和T4翻译缺口。

Project Summary: Delivery of healthcare has been traditionally limited to in-person office visits or hospitalizations, while patients spent the majority of their time at home or work. Digital Medicine (e.g. apps, remote monitoring, telemedicine, patient reported outcomes [ePRO]) has the potential to bridge this gap, but it is unclear how to implement in a mainstream clinical practice that can lead to high-level patient and provider adoption. Through the creation of a Digital Transformation Network (DTN) for Inflammatory Bowel Disease (IBD), we plan to reduce digital disparities and scientifically address the evidence gap of digital health interventions across populations and communities. AIM I. Unify existing digital assets (mobile app, ePROs, assessment for digital disparities and behavioral health, referral to IBD home and health education) into an IBD Digital Therapeutics Toolkit and integrate with EHRs at 3 CTSA hubs. Hypothesis: Integration with EHRs will lead to higher adoption by providers and limit disruption of workflow. AIM II: Establish baseline levels of digital connectivity, disease control, quality of life and care metrics in cohorts at the three IBD centers. Hypothesis: A multipronged approach of assessment through text, phone, an app, and in-person will yield higher adoption. AIM III. Implement and evaluate precision-matched interventions (digital skills, social determinants, behavioral health, monitoring through apps, and referral to interdisciplinary care) among 1500 patients with IBD using a stepped-wedge, cluster- randomized trial. Hypothesis: Medical homes supported by a unified platform will translate to sustainable improvement in population health outcomes. Analyze the Impact of DTN interventions. The primary outcome will be the improvement of the percentage of patients in DTN in disease control and decrease in urgent care utilization (emergency department visits and hospitalization days) across the three CTSA sites. AIM IV. Support sustainability and dissemination across CTSA sites. Hypothesis: The patient- centric DTN will be sustainable through alignment with value-based healthcare. Anticipated Impact: About 2 million Americans suffer from IBD and many more with chronic inflammatory diseases. We hope that this study will help us build an evidence-based approach to determine whether digital medicine can engage a diverse group of patients and improve outcomes; and if yes, how it can be reproduced and replicated across different settings to address theT3 and T4 translational gaps.