A Digital Patient Decision Aid to Increase Sexually Transmitted Infection Testing in the Emergency Department: The STIckER Study

数字患者决策辅助工具可增加急诊科的性传播感染检测：STIckER 研究

• 批准号: 10618216
• 负责人: Lauren Stephanie Chernick
• 金额: $ 20.56万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-05 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10618216
• 关键词: Accident and Emergency department; Address; Adolescent and Young Adult; Adult; Affect; African American; Bioinformatics; Biometry; Black race; Caring; Centers for Disease Control and Prevention (U.S.); Childhood; Chlamydia; Clinic; Clinical; Clinical Trials; Code; Color; Contraceptive Usage; Data; Decision Aid; Decision Making; Detection; Development; Disease; Disparity; Emergency Care; Emergency Department patient; Emergency Medicine; Emergency department visit; Enrollment; Epidemic; Equity; Evaluation; Failure; Feedback; Female; Genital; Genitalia; Genitourinary system; Goals; Gonorrhea; HIV Infections; Health; Health education; Hispanic; Infertility; Intervention; Interview; Knowledge; Lead; Learning Module; Malignant Neoplasms; Medical; Minority; Mission; Oropharyngeal; Outcome; Outpatients; Parents; Patient Preferences; Patients; Perinatal; Population; Positioning Attribute; Prevention approach; Probability; Process; Provider; Randomized; Recommendation; Recording of previous events; Reproducibility; Research; Resources; Scanning; Sexual Health; Sexual and Gender Minority Youth; Sexually Transmitted Diseases; Source; Specific qualifier value; Testing; Time; Training; Underserved Population; United States; United States National Institutes of Health; Woman; Work; aged; burden of illness; condoms; cost; design; digital; digital health; digital intervention; efficacy outcomes; empowerment; evidence base; evidence based guidelines; fetal; heuristics; implementation barriers; implementation science; improved; infection rate; infection risk; innovation; men; multidisciplinary; neighborhood disadvantage; novel strategies; patient oriented; patient screening; pediatric emergency; prototype; racial minority; randomized trial; recruit; screening; sex; sexual health intervention; sexually active adolescent; shared decision making; socioeconomic disadvantage; symptomatology; tool; treatment as usual; usability

ABSTRACT Improved screening for sexually transmitted infections (STI) is essential to reversing the STI epidemic in the United States (US). Nearly half of STIs in the US occur in adolescent and young adults (AYA) aged 15-24, and failure to perform genitourinary and extra-genital (anorectal and oropharyngeal) STI testing contributes to the propagation of disease. Emergency Departments (ED) care for over 17 million AYA each year, the majority being poor and minority. Our prior work demonstrated the inconsistent use of contraceptives among this population, and how, although ED providers are receptive to ED-based sexual health interventions, implementation barriers persist, such as limited time and resources. Innovative interventions are needed that fit efficiently within the ED workflow and maximize appropriate STI testing. One such intervention would be a patient decision aid that informs and empowers AYA patients who may benefit from STI testing. Patient decision aids have been used to successfully facilitate shared decision-making in the ED for various clinical scenarios. We have gathered a multi- disciplinary team of experts in pediatric, adult, and emergency medicine, ED-based clinical trials, digital health, implementation science, biostatistics, and shared decision-making to develop STIckER (STI ChecK in the ER), an evidence-based, digital patient decision aid to facilitate STI testing in the ED using a shared decision-making approach. STIckER consists of three steps: (1) the patient “scanning the sticker” via a QR code leading to a non- judgmental sexual health screening assessment; (2) shared decision-making educational modules connecting personalized STI risk to evidence-based testing recommendations; and (3) facilitation of a patient-provider STI testing conversation using a confidential, color-coded digital infographic. The specific aims of this proposal are (1) To refine “STIckER,” our STI testing patient decision aid through an iterative development approach based on stakeholder feedback; (2) To conduct usability testing and finalize development of STIckER; and (3) To conduct a pilot randomized trial to examine the preliminary efficacy and implementation of STIckER in the ED. We hypothesize that sexually active AYA who interact with STIckER will more often undergo any STI testing compared with sexually active AYA who do not interact with STIckER. SIGINIFICANCE: An effective, automated digital intervention increasing STI testing can be utilized in other EDs as a reproducible means to promote the provision of evidence-based sexual health education, decrease STI rates, and improve AYA health outcomes throughout the US.

抽象的 改进性传播感染（STI）的筛查对于逆转STI流行至关重要 美国（美国）。美国近一半的性传播感染发生在青少年和年轻人（AYA）15-24岁的年轻人， 未能执行泌尿生殖器和外生（厌食和口咽）STI测试有助于 疾病的传播。急诊部（ED）每年有1700万AYA的护理，大多数是 贫穷和少数群体。我们先前的工作证明了该人群中避孕药的使用不一致， 以及如何接受基于ED的性健康干预措施，但如何实施障碍 坚持不懈，例如有限的时间和资源。需要有效地在ED内进行创新干预措施 工作流并最大化适当的性传播疾病测试。这样的干预将是患者的决策援助 向可能受益于STI测试的AYA患者的通知和授权。患者决策辅助工具已习惯 在各种临床情况下成功地促进了ED中共同的决策。我们已经收集了一个多 儿科，成人和急诊医学专家的纪律团队，基于ED的临床试验，数字健康， 实施科学，生物统计学和共享决策以开发标签（STI检查）， 基于证据的数字患者决策辅助 方法。贴纸由三个步骤组成：（1）患者通过QR码“扫描贴纸”，导致非 - 判断性健康筛查评估； （2）共享决策教育模块连接 个性化的STI风险对循证测试建议； （3）促进患者的性传播疾病 使用机密的，颜色编码的数字信息图来测试对话。该提议的具体目的是 （1）为了完善“贴纸”，我们通过基于迭代发展方法来测试患者的决策援助 关于利益相关者的反馈； （2）进行可用性测试并确定贴纸的开发； （3）到 进行试验随机试验，以检查ED中标签的初步效率和实施。 我们假设与贴纸互动的性活跃的AYA会经常进行任何性传播疾病测试 与不与贴纸互动的性活跃的AYA相比。 sigificence：有效的自动化 数字干预措施增加的性传播感染测试可以在其他ED中用作可再现的手段来促进 提供基于证据的性健康教育，降低性传播感染率并改善AYA健康结果 整个美国。