Improving HIV Care with mHealth Tools: An App to Detect Neurocognitive Impairment

使用移动医疗工具改善艾滋病毒护理：检测神经认知障碍的应用程序

• 批准号: 9037711
• 负责人: Reuben N Robbins
• 金额: $ 20.79万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9037711
• 关键词: AIDS prevention; Activities of Daily Living; Address; Adherence; Adult; Affect; Android; Attention; Behavior; Behavioral; Big Data; Caring; Case Manager; Chronic; Clinic; Clinical; Clinical Research; Communication; Computerized Medical Record; Data; Databases; Detection; Development; Device Designs; Disease; Early Diagnosis; Electronics; Ensure; Epidemiology; Equipment; Face; Foundations; Future; Good Clinical Practice; HIV; Health; Health Personnel; Health Services Accessibility; Health system; Healthcare; Home visitation; House Call; Human; Human Resources; Impairment; Individual; Instruction; Intervention; Learning; Life; Measures; Medical; Medical Electronics; Medical Records; Meta-Analysis; Methods; Monitor; Motor; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Nurses; Outcome; Paper; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Population; Population Database; Preventive Intervention; Primary Health Care; Provider; Public Health; Quality of life; Reaction Time; Research; Resources; Risk; Rural; Short-Term Memory; Specialist; Staging; System; Tablets; Testing; Time; Training; Treatment outcome; Viremia; antiretroviral therapy; base; clinical care; clinical practice; design; digital; handheld mobile device; implementation trial; improved; instrument; mHealth; medication compliance; memory process; mild neurocognitive impairment; mobile computing; mortality; novel; portability; prevention service; processing speed; screening; therapy adherence; tool; touchscreen; transmission process; treatment adherence; usability

 DESCRIPTION (provided by applicant): Neurocognitive impairment (NCI) is one of the most common clinical conditions seen in HIV, affecting as many as 70% of infected individuals, including those on antiretroviral therapy (ART) and with well-controlled viremia. The NCI seen in HIV has significant medical, functional, and public health consequences (e.g., problems adhering to ART), but often goes undetected in the clinical setting. Routine screening for HIV-related NCI can enhance provider-patient communication to help patients with NCI better manage their ART adherence and other health outcomes, but doing so faces challenges. For instance, most screening tools for NCI in HIV clinics are paper-and-pencil tests prone to administration and scoring errors that require highly trained personnel to administer, score and interpret, require additional equipment, and are not well-suited for modern clinics utilizing electronic medical records. To address this public health and medical practice gap, we have developed an mHealth tool to make screening more accessible and sustainable in the modern clinical setting. NeuroScreen is a brief, easy-to-use NCI screening test application (app) for Android mobile devices designed to be administered by a wide range of non-expert healthcare personnel. The app is highly automated (e.g., does not require any record keeping or scoring) with standardized instructions ensuring consistent administrations each and every time with minimal training. NeuroScreen is ultra-portable (i.e., usable in any clinic exam room, remote and rural settings, or during home visits) and totally self-contained (i.e., no need for paper forms, pens, stopwatches, or other apparatuses). Results from NeuroScreen are available immediately and can be transmitted electronically to a variety of end-users, such as primary care providers, HIV specialists and/or electronic medical records, as well as to databases for population level monitoring. This study will assess the usability and acceptability of a tablet-based NeuroScreen by HIV care providers of differing expertise levels (e.g., physicians, nurses, and case managers), and identify provider- and clinic-level facilitators and barriers to integrating this mHealth tool into clinical practice. The study will then evaluate NeuroScreen's accuracy to detect mild NCI in 182 HIV-infected adults with NCI (n=91) and without NCI (n=91). With an easy-to-use and accurate tool to detect NCI and well-suited for clinics using and moving towards electronic medical systems, early detection and on-going monitoring of impairment could be realized and help healthcare providers communicate more effectively with patients about their treatment and care, make better referrals, and offer tailored ART adherence interventions and strategies as well as HIV prevention services. Furthermore, NeuroScreen offers health systems a viable method to collect large quantities of neurocognitive data suited to population level epidemiological research and other studies utilizing big data. An mHealth tool, like NeuroScreen, could be easily modified for use in other disease populations and regions of the world that rely on task-shifting due to very limited healthcare resources.

 描述（由适用提供）：神经认知障碍（NCI）是艾滋病毒中最常见的临床疾病之一，影响了多达70％的感染个体，包括抗逆转录病毒疗法（ART）和控制良好的病毒血症。 NCI在HIV中看到的具有重大的医疗，功能和公共卫生后果（例如，遵守艺术的问题），但在临床环境中常常没有发现。与HIV相关的NCI进行常规筛查可以增强提供者的沟通，以帮助NCI患者更好地管理其艺术依从性和其他健康状况，但是这样做会面临挑战。例如，HIV诊所中NCI的大多数筛查工具都是纸笔测试，这些纸笔测试容易用于管理和评分错误，这些错误需要训练有素的人来管理，评分和解释，需要其他设备，并且不适合利用电子病历的现代诊所。为了解决这个公共卫生和医学实践差距，我们开发了一种MHealth工具，以使筛查在现代临床环境中更容易获得和可持续。 Neuroscreen是一个简短，易于使用的NCI筛选测试应用程序（APP），适用于旨在由各种非专家医疗人员管理的Android移动设备。该应用程序是高度自动化的（例如，不需要任何记录保存或评分），并通过标准化说明确保每次通过最少的培训来确保持续的管理。 Neuroscreen是可超便携式的（即，在任何诊所检查室，远程和粗糙的设置，或在家探访期间可用），并且完全独立（即，不需要纸质形式，笔，秒表，秒表或其他设备）。可立即获得神经扫描的结果，可以通过电子方式传输到各种最终用户，例如初级保健提供者，HIV专家和/或电子病历，以及用于人口级别监测的数据库。这项研究将评估差异化专业水平（例如医师，护士和病例经理）的艾滋病毒护理提供者基于平板电脑的神经镜的可用性和可接受性，并确定提供者和临床级别的促进者以及将这种MHealth疗法整合到临床实践中的障碍。然后，该研究将评估神经锁菌素的准确性，以检测具有NCI（n = 91）和没有NCI（n = 91）的182名HIV感染的成年人中的轻度NCI。可以实现易于使用和准确的工具，可检测NCI和非常适合使用电子系统的诊所，可以实现早期检测和持续监测损害的监测，并帮助医疗保健提供者更有效地与患者进行有关其治疗和护理的治疗，更好地参考，并提供更好的参考，并提供量身定制的艺术依从性干预措施和策略的预测服务。此外，Neuroscreen提供了一种卫生系统，一种可行的方法，可以收集大量适用于人群水平流行病学研究的神经认知数据和使用大数据的其他研究。像Neuroscreen这样的MHealth工具很容易被修改，以用于其他疾病人群和由于医疗资源非常有限而依赖任务转移的地区。