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

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 45% 的自杀者曾拜访过他们的初级保健提供者 (PCP) 在死亡前一个月和前一年为 77%，这使得初级保健诊所成为至关重要的然而，自杀风险筛查的一致性和质量。由于提供者对评估、讨论、和管理自杀，除了自杀意念之外，还需要考虑更广泛的症状和风险因素，以及竞争性医疗需求和无数强制筛查的负担。（CAT）具有解决这些障碍以及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：我们的多学科团队由自杀预防和初级保健方面的专家组成（Davis-Martin、Mullin）；EHR 集成、健康信息学和以用户为中心的设计（Tulu）；（Djamasbi）；医疗保健工作流程重新设计（Johnson）；实施科学（Davis-Martin，Johnson）；经济学（辛格）；隐私/道德（内贝克尔）；和 CAT（吉本斯）将共同努力实现这些目标。创新：使用 CAT 来解决自杀的初步检测、量化和纵向监测初级保健中一系列心理健康指标中包含的风险是新颖的，我们将为此制定一个方案。初级保健诊所的下游全系统部署，使患者能够轻松获得完整的 CAT 通过多种方式优化 CAT 结果呈现，以实现最大的临床效用。方法：我们将利用关键信息来研究 CAT-MHTM 在三个护理环境中的现有实施情况与临床管理者和提供者访谈，以确定临床工作流程的变化、障碍部署以及实现有效 EHR 集成、HIPAA 合规性、用户接受度和策略我们将把 CAT-MHTM 集成到麻省大学 EHR 测试环境中，反映各种工作流程。并显示确定的初级保健医疗和行为健康工头样本（n~10）。在 UMass iCELS 中，我们将捕获标准化患者的 CAT-MHTM 结果显示利用率。我们使用眼动追踪技术来识别设计的优点/缺点。将测试在一个初级保健诊所中对东部和实际患者部署 CAT-MHTM 的可行性 EPIS 框架指导和实施 CQI 方法以确定最合适的临床工作流程。实施措施将包括可接受性、可用性、可行性、影响范围、保真度和简单成本计算。环境：麻省大学、WPI 和 ATT 已在众多联邦政府资助的项目上成功合作（R44MH118780、R44DA049448、NSF-IIS-1065298）。影响：本研究将用作后续实施试验 R01 的试点数据，该试验将研究将更新的 CAT-MHTM 和工作流程实施到麻省大学剩余的初级保健实践中。