Exploratory Research Project - CAT

探索性研究项目 - CAT

基本信息

批准号：
10577121
负责人：
Rachel Elizabeth Davis-Martin
金额：
$ 13.7万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-05 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10577121
关键词：
Acceleration Active Learning Address Administrator Adoption Adult Ambulatory Care Facilities Anxiety Behavior Caring Cause of Death Cellular Phone Cessation of life Clinic Clinical Collaborations Communication Tools Communities Coupling Data Detection Development Economics Electronic Health Record Ensure Environment Ethics Evidence based practice Family Feeling suicidal Funding Health Insurance Portability and Accountability Act Healthcare Hylobates Genus Individual Insurance Carriers Intervention Interview Joints Life Expectancy Medical Mental Depression Mental Health Mental Tests Modality Monitor Morbidity - disease rate National Institute of Mental Health Pathway interactions Patient Education Patients Persons Point of Care Technology Population Primary Care Privacy Procedures Provider Public Health Informatics Publishing Recommendation Research Personnel Research Project Grants Resources Risk Risk Factors Sampling Site Specialist Standardization Substance abuse problem Suicide Suicide prevention Symptoms System Tablets Techniques Technology Test Result Testing Thinness Time Translating Translations United States Update Variant Vendor Visit Work base behavioral health clinical decision support clinical decision-making clinical practice computerized cost dashboard design effective intervention experience feasibility testing implementation measures implementation science implementation strategy implementation trial improved informant innovation mortality multidisciplinary novel patient health information patient portal prevent primary care clinic primary care practice primary care provider psychiatric symptom screening simulation success suicidal risk translational barrier trend uptake usability user centered design validation studies visual tracking

Acceleration Active Learning Address Administrator Adoption Adult Ambulatory Care Facilities Anxiety Behavior Caring Cause of Death Cellular Phone Cessation of life Clinic Clinical Collaborations Communication Tools Communities Coupling Data Detection Development Economics Electronic Health Record Ensure Environment Ethics Evidence based practice Family Feeling suicidal Funding Health Insurance Portability and Accountability Act Healthcare Hylobates Genus Individual Insurance Carriers Intervention Interview Joints Life Expectancy Medical Mental Depression Mental Health Mental Tests Modality Monitor Morbidity - disease rate National Institute of Mental Health Pathway interactions Patient Education Patients Persons Point of Care Technology Population Primary Care Privacy Procedures Provider Public Health Informatics Publishing Recommendation Research Personnel Research Project Grants Resources Risk Risk Factors Sampling Site Specialist Standardization Substance abuse problem Suicide Suicide prevention Symptoms System Tablets Techniques Technology Test Result Testing Thinness Time Translating Translations United States Update Variant Vendor Visit Work base behavioral health clinical decision support clinical decision-making clinical practice computerized cost dashboard design effective intervention experience feasibility testing implementation measures implementation science implementation strategy implementation trial improved informant innovation mortality multidisciplinary novel patient health information patient portal prevent primary care clinic primary care practice primary care provider psychiatric symptom screening simulation success suicidal risk translational barrier trend uptake usability user centered design validation studies visual tracking

展开

项目摘要

CATS (EXPLORATORY PROJECT): ABSTRACT Significance: Approximately 45% of individuals who die by suicide had a visit with their primary care provider (PCP) in the month prior to their death and 77% in the year prior, making primary care clinics a crucial environment for identifying suicide risk. However, consistency and quality of screening for suicide risk in this setting vary widely by provider and clinic because of differences in providers’ comfort with assessing, discussing, and managing suicide, the need to consider broader symptoms and risks factors in addition to suicidal ideation, and the burden of competing medical demands and myriad mandated screenings. Computerized adaptive tests (CATs) have transformative potential for addressing these barriers and identifying and tracking mental health conditions, including suicide risk in primary care. Investigators: Our multi-disciplinary team comprised of specialists in suicide prevention and primary care (Davis-Martin, Mullin); EHR integration, health informatics and user-centered design (Tulu); user experience (Djamasbi); healthcare workflow redesign (Johnson); implementation science (Davis-Martin, Johnson); economics (Singh); privacy/ethics (Nebeker); and CATs (Gibbons) will work together to accomplish the Aims. Innovation: Using CATs to address initial detection, quantification, and longitudinal monitoring of suicide risk embedded in a range of mental health indicators in primary care is novel. We will create a package for downstream system-wide deployment for primary care clinics that enables easy patient access to complete CATs through multiple modalities and optimizes CATs results presentation for maximum clinical utility. Approach: We will study existing implementations of CAT-MHTM in three care settings, using key informant interviews with clinical administrators and providers, to identify variations in clinical workflows, barriers to deployment, and strategies for achieving effective EHR integration, HIPAA compliance, user acceptance, and clinical utility. We will integrate CAT-MHTM into the UMass EHR test environment, reflecting various workflows and result displays identified. A sample of primary care medical and behavioral health clinicians (n~10) will test alternatives, in the UMass iCELS, with standardized patients. We will capture CAT-MHTM result display utilization with eye tracking technology and identify strengths/weaknesses of designs using talk-through techniques. We will test the feasibility of deploying CAT-MHTM with clinicians and actual patients in one primary care clinic using the EPIS framework to guide implementation and a CQI approach to determine the best fitting clinical workflow. Implementation measures will include acceptability, usability, feasibility, reach, fidelity and simple costing. Environment: UMass, WPI, and ATT have successfully collaborated on numerous federally funded projects (R44MH118780, R44DA049448, NSF-IIS-1065298). Impact: This study will be used as pilot data for the subsequent implementation trial R01 that will study the implementation of the updated CAT-MHTM and workflows into the remaining primary care practices at UMass.

猫（探索性项目）：摘要意义：大约有45％的自杀死亡的人访问了其初级保健提供者（PCP）在他们去世前的一个月和前一年的77％，使初级保健诊所成为至关重要的识别自杀风险的环境。但是，在此中，一致性和筛查的自杀风险质量由于提供商和诊所的差异，提供者在评估，讨论，讨论，讨论，讨论，以及管理自杀，除了自杀思想之外，还需要考虑更广泛的符号和风险因素以及相互竞争的医疗需求和无数强制放映的燃烧。计算机化自适应测试（猫）具有解决这些障碍并识别和跟踪心理健康的变革潜力条件，包括初级保健中的自杀风险。调查人员：我们的多学科团队完成了预防自杀和初级保健专家（戴维斯·马丁，穆林）； EHR集成，健康信息和以用户为中心的设计（Tulu）；用户体验（djamasbi）;医疗保健工作流重新设计（约翰逊）；实施科学（约翰逊戴维斯 - 马丁）；经济学（辛格）；隐私/道德（Nebeker）；猫（Gibbons）将共同努力实现目标。创新：使用猫来解决自杀的初始检测，定量和纵向监测在初级保健中的一系列心理健康指标中嵌入的风险是新颖的。我们将为初级保健诊所的下游全系统部署，使患者可以轻松进入完整的猫通过多种方式，并优化猫的结果表现，以最大程度地临床实用性。方法：我们将使用主要线人在三个护理环境中研究CAT-MHTM的现有实施与临床管理员和提供者的访谈，以确定临床工作流程的差异，障碍部署和实现有效EHR集成，HIPAA合规性，用户接受和的策略临床实用程序。我们将将CAT-MHTM集成到UMass EHR测试环境中，以反映各种工作流程并确定的结果显示。初级保健医疗和行为健康临床医生（n〜10）的样本将测试在UMass Icels中，有标准化患者的替代方案。我们将捕获CAT-MHTM结果显示利用率借助眼睛跟踪技术，并使用谈话技术确定了设计的优势/劣势。我们将测试使用临床医生和实际患者在一个初级保健诊所中部署CAT-MHTM的可行性引导实施的EPIP框架和确定最佳拟合临床工作流程的CQI方法。实施措施将包括可接受性，可用性，可行性，覆盖范围，忠诚度和简单成本。环境：UMass，WPI和ATT已成功合作在众多联邦资助项目上（R44MH118780，R44DA049448，NSF-IIS-1065298）。影响：这项研究将用作随后实施试验R01的试验数据，该试验将研究将更新的CAT-MHTM和工作流程实施到UMass的其余初级保健实践中。