Integrating mHealth for Alcohol Use Disorders into Clinical Practice

将针对酒精使用障碍的移动医疗融入临床实践

• 批准号: 10152469
• 负责人: Andrew Quanbeck
• 金额: $ 66.41万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10152469
• 关键词: Address; Authorization documentation; Caring; Cellular Phone; Chronic Disease; Clinic; Clinical; Competence; Cost Analysis; Cost Savings; Data; Development; Devices; Diagnosis; Drug Metabolic Detoxication; Electronic Health Record; Emergency department visit; Environment; Focus Groups; Future; Gender; Group Interviews; Health Technology; Health system; Hospitalization; International; Intervention; Interview; Mediating; Medicine; Monitor; Motivation; Names; Outcome; Patient Care; Patient Monitoring; Patient Recruitments; Patient-Focused Outcomes; Patients; Play; Primary Health Care; Process; Provider; Qualitative Methods; Qualitative Research; Quality of life; Randomized; Randomized Controlled Trials; Research; Research Design; Research Personnel; Residential Treatment; Role; Savings; Services; Stream; Structure; Subgroup; Substance Use Disorder; System; Testing; Time; Woman; Work; addiction; alcohol abuse therapy; alcohol use disorder; clinical care; clinical practice; cost; dashboard; design; drinking; effectiveness implementation study; evidence base; health care delivery; health care service utilization; health data; health economics; health information technology; high risk drinking; hybrid type 1 design; implementation process; implementation research; implementation study; innovation; intervention effect; mHealth; men; multidisciplinary; patient response; reduced alcohol use; response; smartphone Application; treatment as usual; treatment planning

Project Summary/Abstract Mobile health (mHealth) technologies (e.g., smartphone applications) have the potential to continuously monitor patients and deliver interventions when and where they are needed. These features make mHealth particularly promising for the treatment of alcohol and other substance use disorders. Patient-provided data from mHealth devices could also help clinicians plan treatment and respond to patients. Yet mHealth is rarely integrated into treatment, in part because so few evidence-based mHealth systems are available. This project addresses the potential of using mHealth to treat alcohol use disorder (AUD) in primary care clinics. Two questions drive the project: (1) Is A-CHESS, an mHealth system that has been proven effective for patients leaving residential treatment for AUD, effective with patients in primary care? (2) Are the costs associated with integrating A-CHESS into clinical processes worthwhile, or does it suffice for patients to use A-CHESS independently, without integration into the electronic health record and clinician monitoring? The project uses a Type 1 hybrid design (examining both patient outcomes and implementation) to answer these questions. Patients will be randomly assigned to (1) usual care for AUD, (2) a clinician-mediated group in which patients receive A-CHESS and clinicians monitor patient-supplied A-CHESS data from a dashboard integrated into the electronic health record, or (3) a patient-directed group in which clinicians simply encourage patients to use A-CHESS on their own. The quantitative analysis will examine differences between the groups in risky drinking days and quality of life to test the hypothesis that patients in the clinician-mediated group will have greater improvements than patients in the usual care group. Additionally, we hypothesize that patients in both A-CHESS groups will have greater improvements in risky drinking days and quality of life vs. patients in the usual care group, and those in the clinician-mediated group will see the greatest improvements. Subgroup analyses will be conducted to understand the relationship between the outcomes and (1) gender, (2) patient and clinician responses to alerts generated by A-CHESS, and (3) use of A-CHESS. The qualitative analysis will mainly seek to understand how clinicians use the dashboard to monitor patient care. Semi- structured interviews will inquire about the amount of dashboard use, potential contamination (whether clinicians used approaches suggested by the dashboard with patients in the other two groups), and the quality of intervention delivery. Finally, the cost analysis will determine the cost of integrating A-CHESS into clinical practice vs. the cost of patients using A-CHESS independently, and whether the cost of clinically integrating A- CHESS is offset by savings from reduced AUD-related care (e.g., hospitalizations, ER visits, residential treatment, and detoxification). This research will inform clinical leaders and policymakers on whether and how mHealth systems should be incorporated into clinical care to treat AUD and potentially other chronic diseases.

项目摘要/摘要 移动健康（MHealth）技术（例如，智能手机应用程序）有可能连续 监测患者并在需要时提供干预措施。这些功能使MHealth 对于治疗酒精和其他物质使用障碍的有希望。患者提供的数据 来自MHealth设备还可以帮助临床医生计划治疗并对患者做出反应。但是MHealth很少 集成到治疗中，部分原因是很少有基于证据的MHealth系统可用。 该项目涉及使用MHealth治疗初级酒精使用障碍（AUD）的潜力 护理诊所。两个问题推动了该项目：（1）是A-Chess，这是一个已被证明的MHealth系统 对于离开住宅治疗AUD的患者有效，在初级保健中对患者有效？ （2）是 与将A-schess整合到值得的临床过程中相关的成本，或者足以让患者 独立使用A-Chess，而无需集成到电子健康记录和临床医生监测中？ 该项目使用1型混合设计（检查患者结果和实施） 回答这些问题。患者将被随机分配到（1）AUD的常规护理，（2）临床医生介导的 患者接受A董事和临床医生监测患者提供的A列船长数据的组 集成到电子健康记录中的仪表板，或（3）临床医生简单的患者指导组 鼓励患者自己使用A-Chess。定量分析将检查 危险饮酒日和生活质量的群体，以检验临床医生介导的患者的假设 在通常的护理组中，小组的进步将比患者更大。此外，我们假设 两个A-CESS组的患者在危险的饮酒日和生活质量VS上都将有更大的改善。 常规护理组的患者以及临床医生介导的组中的患者将看到最大的改善。 将进行亚组分析，以了解结果与（1）性别之间的关系，（2） 患者和临床医生对A-Chess产生的警报的反应，以及（3）使用A-Chess。定性 分析将主要寻求了解临床医生如何使用仪表板来监控患者护理。半- 结构化的访谈将询问使用仪表板的使用量，潜在的污染（是否 临床医生使用仪表板建议的其他两组患者提出的方法）和质量 干预交付。最后，成本分析将确定将A-Chess整合到临床上的成本 练习与使用A-Chess的患者的成本与患者的成本，以及临床整合A-的成本是否存在 国际象棋被减少与听力相关的护理节省的抵消（例如，住院，急诊室，住宅 治疗和排毒）。这项研究将告知临床领导者和政策制定者是否以及如何 MHealth系统应纳入临床护理中，以治疗AUD和可能其他慢性疾病。