A Randomized Controlled Trial of a Digital Patient Decision Tool to Increase Sexually Transmitted Infection Testing in the Emergency Department
Abstract
Study objective: To evaluate the efficacy of a digital patient decision aid, Sexually Transmitted Infection Check in the Emergency Room (STIckER), in increasing sexually transmitted infection testing among adolescents and young adults in the emergency department (ED).
Methods: We conducted a randomized controlled trial in adult and pediatric EDs at a large urban academic medical center. We randomized health care clinicians to deliver either the STIckER digital decision aid or usual care to sexually active adolescents and young adults patients aged 14 to 24 years. The tool, developed through human-centered design, provided personalized sexually transmitted infection testing recommendations and values clarification exercises via smartphone. The primary outcome was documentation of gonorrhea/chlamydia testing. Secondary outcomes included extragenital testing, patient-reported decisionmaking measures, and implementation. We conducted descriptive statistics of patient-level and health care provider-level outcomes by study arms. We estimated the efficacy of STIckER using log-binomial regression.
Results: We randomized 44 health care clinicians and enrolled 139 adolescents and young adult participants (median age 19 years). Participants in the STIckER arm were 1.76 times more likely to receive gonorrhea/chlamydia testing (95% confidence interval, 1.10 to 3.00) and 4.56 times more likely to receive pharyngeal testing (95% confidence interval, 1.30 to 28.66). Participants in the…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 139 participants or records.
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