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Principal Investigator: Monika Kumari Goyal
Organization: CHILDREN'S RESEARCH INSTITUTE
Fiscal Year: 2024
Award: $695,471
Funding agency: National Institute of Allergy and Infectious Diseases
Project Abstract
Adolescents account for nearly half of all new sexually transmitted infection (STI) cases annually, and of those,
non-Hispanic Black and Hispanic youth are disproportionately affected. These disparities are attributed, in part,
to differential access to and routine use of quality health care, including STI prevention and treatment. The
overarching goal of our research efforts are to improve adolescent sexual health outcomes and mitigate
disparities in STI rates by leveraging health information technology (HIT) in the emergency department (ED) to
enable detection and treatment of STIs through shared decision making. The objective of this proposal is to
scale and optimize our successful process in improving STI testing rates by leveraging HIT to: 1) seamlessly
integrate broad-scale targeted STI screening through the provision of real-time, electronic health record
embedded, clinical decision support (CDS) based on patient-reported STI-risk assessment into the normal ED
workflow to improve STI detection and 2) use mobile Health (mHealth) to improve STI treatment rates. Building
on our preliminary work, the specific aims are to: 1) use a human factors engineering approach to implement
and optimize a broad-scale computer-facilitated STI screening process into the clinical workflow of the ED; 2)
compare differences in STI detection rates between a sexual health screening (SHS)-derived electronic CDS
strategy versus usual care (no provision of CDS); and 3) compare differences in treatment adherence between
patients receiving text messages versus those receiving usual care (no text messages). Within the first aim, we
will use a human factors engineering approach to conduct workflow analyses which will inform the refinement
of implementation of an STI screening process into the clinical workflow of the ED. In the second aim, we will
conduct a pragmatic trial using an interrupted time series design to measure the impact of SHS-derived
electronic CDS on STI detection rates. In the third aim, we will conduct a randomized clinical trial, nested within
the pragmatic trial, to measure the impact of a two-way text-messaging intervention to improve treatment rates
through identifying and addressing barriers to STI treatment adherence. This innovative approach leverages
HIT to electronically integrate patient-reported sexual risk data to guide CDS and mHealth to improve
treatment adherence. We expect our contribution to help improve sexual health outcomes and reduce
disparities in the burden of STIs among at-risk, vulnerable adolescents by increasing STI detection and
treatment adherence. The proposed work is significant because it has the potential to improve the health of the
millions of adolescents who access EDs as their only source of healthcare and impact national policies related
to STI detection and treatment. In addition, this work can provide proof of concept for leveraging HIT to deliver
patient-centered care with shared decision making to address health care disparities and improve healthcare
quality and outcomes, which can be applied to other types of screening interventions in the future.
Terms: <2 way SMS><2 way text messaging><2 way texting><Access to Care><Accident and Emergency department><Acute><Address><Adherence><Adolescent><Adolescent Youth><Affect><Black><Black race><Children's Hospital><Cities><Clinical><Communities><Computers><Data><Data Reporting><Decrease disparity><Detection><Development><Diagnosis><Disparities><Disparity><ED care><ED-based intervention><ER care><Effectiveness><Electronic Health Record><Electronics><Emergency Care><Emergency Department><Emergency Department care><Emergency Department-based Intervention><Emergency Room care><Emergency health care><Emergency healthcare><Emergency medical care><Emergency room><Engineering><Epidemic><Fear><Fright><Future><General Population><General Public><Goals><Health><Health Care Technology><Health Services><Health Services Accessibility><Health Technology><Healthcare><Healthcare Technology><Hispanic><Human><Interruption><Intervention><Intervention Strategies><Interview><Judgment><K23 Award><K23 Mechanism><K23 Program><Lower disparity><Measures><Mentored Patient-Oriented Research Career Development Award><Mentored Patient-Oriented Research Career Development Award (K23)><Mission><Modeling><Modern Man><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Outcome><Paper><Patient Outcomes Assessments><Patient Reported Measures><Patient Reported Outcomes><Patient-Centered Care><Patients><Pediatric Hospitals><Persons><Pilot Projects><Policies><Population><Privacy><Process><Public Health><Randomization trial><Randomized><Reporting><Research><Research Resources><Resources><Risk><Risk Assessment><STD prevention><STI prevention><Series><Services><Sexual Health><Sexually Transmitted Diseases><Sexually Transmitted Disorder><Sexually Transmitted Infection><Source><Survey Instrument><Surveys><Testing><Text Messaging><Time><Transportation><Venereal Diseases><Venereal Disorders><Venereal Infections><Visit><Work><Youth><Youth 10-21><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><adherence by clinicians><adherence by providers><adolescent sexual health><availability of services><bi-directional SMS><bidirectional SMS><burden of disease><burden of illness><care access><care as usual><clinical decision support><clinical practice><clinician adherence><clinician compliance><computerized><cost><data representation><data representations><design><designing><developmental><disease burden><disparate effect><disparate impact><disparate result><disparity in care><disparity in health><disparity in healthcare><disparity reduction><electronic><electronic device><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><health assessment><health care><health care access><health care availability><health care disparity><health care inequality><health care inequity><health care quality><health care service access><health care service availability><health disparity><health information technology><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare disparity><healthcare inequality><healthcare inequity><healthcare quality><healthcare service access><healthcare service availability><high risk><high risk group><high risk individual><high risk people><high risk population><high-risk adolescents><improved><inequitable effect><inequitable impact><inequitable outcome><infection management><infection rate><innovate><innovation><innovative><interest><interventional strategy><juvenile><juvenile human><juvenile sexual health><m-Health><mHealth><marginalization><mitigate disparity><mobile health><outcome disparities><outcome inequality><outcome inequity><participant engagement><patient engagement><physician adherence><physician compliance><pilot study><population health><pragmatic effectiveness trial><pragmatic trial><prevent sexually transmitted disease><prevent sexually transmitted infections><process improvement><provider adherence><provider compliance><randomisation><randomization><randomized trial><randomized, clinical trials><randomly assigned><rate of infection><reduce disparity><reduction in disparity><risk stratification><screening><screenings><service availability><sexually acquired infection><sexually transmitted disease prevention><sexually transmitted infection prevention><shared decision making><short message service><social stigma><stem><stigma><stratify risk><text based intervention><text intervention><text messaging based intervention><text messaging intervention><texting><tool><treatment access><treatment adherence><treatment as usual><treatment compliance><treatment program><trial design><two way SMS><two way text messaging><two way texting><unequal effect><unequal impact><unequal outcome><usual care><vulnerable adolescent>