Improving the Detection of STIs in the Pediatric Emergency Department: A Pragmatic Trial

改善儿科急诊科性传播感染的检测：一项务实的试验

• 批准号: 10466870
• 负责人: Monika Kumari Goyal
• 金额: $ 61.16万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10466870
• 关键词: Accident and Emergency department; Acute; Address; Adolescent; Affect; Applied Research; Centers for Disease Control and Prevention (U.S.); Chlamydia; Clinical; Collaborations; Communities; Cost Effectiveness Analysis; Cost Savings; Data Reporting; Detection; Development; Diagnosis; Early Diagnosis; Effectiveness; Electronic Health Record; Emergency Care; Epidemic; Evaluation; Factor Analysis; Failure; Funding; Goals; Gonorrhea; HIV; Health; Health Care Costs; Health Services; Healthcare; Healthy People 2020; High Prevalence; Human; Infection; Infection Control; Institutes; Intervention; Knowledge; Literature; Methods; Modeling; National Institute of Child Health and Human Development; Patients; Pediatric Hospitals; Policies; Population; Populations at Risk; Positioning Attribute; Prevalence; Prevention approach; Prevention strategy; Preventive Health Services; Preventive healthcare; Privacy; Probability; Process; Provider; Public Health; Recommendation; Research; Research Personnel; Resources; Risk; STI prevention; Sampling; Sexual Health; Sexually Transmitted Diseases; Site; Source; Structure; System; Testing; Time; Translating; Work; Youth; base; clinical care; clinical decision support; clinical practice; comparative effectiveness; compare effectiveness; computed tomography screening; cost effective; cost-effectiveness evaluation; disease transmission; evidence base; health care settings; high risk population; high risk sexual behavior; implementation barriers; improved; infection burden; infection risk; innovation; insight; mortality; novel; pediatric emergency; pragmatic trial; public health priorities; reproductive morbidity; screening; screening program; time interval; transmission process; treatment as usual

Project Summary: Sexually transmitted infections (STIs) are highly prevalent among adolescents. Despite established principles for STI control, clinical practices related to screening and diagnosis, treatment, and prevention of STIs among adolescents are suboptimal. There is an urgent need to expand our screening programs to nontraditional healthcare settings such as emergency departments (ED) to reach those adolescents who would otherwise not receive preventive healthcare, and to determine the most efficient and cost-effective method for providing this screening. The goal of this application is to leverage our recent insights obtained from single center ED-based adolescent gonorrhea and chlamydia screening research and apply them across a national pediatric ED research network to determine the most clinically effective and cost-effective screening approach for adolescents when implemented into a real-world clinical setting through a pragmatic trial. This will be accomplished through a network of children’s hospital EDs with a track record of robust research collaboration (Pediatric Emergency Care Applied Research Network or PECARN). This research will contribute to the evidence base for creating clinically effective, cost-effective, and sustainable GC/CT screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve diagnosis of asymptomatic STIs and decrease the time interval to treatment, consequently decreasing reinfection rates of transmission and the overall STI burden as well as decreasing healthcare costs. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide clinical decision support. This work is significant because it has the potential to shift current ED clinical practice paradigms from only acute health encounters to participation in the broader management of public health, and it will fill gaps in the literature needed to provide evidence for the best method of gonorrhea and chlamydia screening in an ED setting. First, we will apply human factors modeling methods to perform ED workflow evaluations at each participating pediatric ED to determine the most efficient way to integrate the screening process into everyday clinical care. Following these analyses, we will conduct a comparative effectiveness pragmatic trial of targeted STI screening (screening only those disclosing high risk sexual behavior) versus universally-offered STI screening (offered to all, regardless of risk) through electronic integration of patient reported data for provision of clinical decision support. We will then develop decision analytic models to evaluate the cost-effectiveness of targeted screening compared to universally offered screening. This research is novel in that it shifts the usual clinical practice paradigm in the ED from STI diagnosis in symptomatic adolescents to STI screening and prevention, an approach that is critical to addressing the STI epidemic among adolescents.

项目摘要： 性传播感染（STI）在青少年中非常普遍。尽管有既定的原则 对于STI控制，与筛查和诊断，治疗和预防性传播感染有关的临床实践 青少年是次优的。迫切需要将我们的筛选计划扩展到非传统 医疗保健设置，例如急诊科（ED），以接触那些否则不会 接受预防性医疗保健，并确定提供此功能的最有效，最具成本效益的方法 筛选。该应用程序的目的是利用我们从基于单一中心的ED获得的最新见解 青少年淋病和衣原体筛查研究，并将其应用于国家儿科 研究网络，以确定最有效和成本效益的筛选方法 通过务实的试验，青少年在实施到现实世界的临床环境中。这将是 通过儿童医院的ED网络完成，并具有强大的研究合作记录 （小儿紧急护理应用研究网络或PECARN）。这项研究将有助于 创建临床有效，具有成本效益和可持续的GC/CT筛查计划的证据基础 可以成功实施到ED的临床工作流程中。它还将改善诊断 无症状的性传播感染并减少治疗时间间隔，因此降低了 传播和总体传播感染燃烧以及降低医疗费用。这种干预将依靠 一种创新的方法，通过电子方式整合患者报告的数据以指导临床决策支持。 这项工作很重要，因为它有可能将当前的ED临床实践范式转移到 急性健康遇到参与更广泛的公共卫生管理，这将填补 文献需要提供证据，以证明在ED中的淋病和衣原体筛查的最佳方法 环境。首先，我们将采用人为因素建模方法来执行每种工作流程评估 参与儿科，以确定每天将筛查过程集成到每天的最有效方法 临床护理。按照这些分析，我们将对有针对性的比较有效性实用试验 STI筛查（仅筛查那些披露高风险性行为的人）与普遍获得的性传播疾病 通过电子整合患者报告的数据，筛选（不论风险如何） 临床决策支持。然后，我们将开发决策分析模型，以评估 与普遍提供的筛选相比，有针对性的筛查。这项研究是新颖的，因为它改变了通常的 从有症状的青少年的STI诊断到STI筛查和STI筛查和 预防，这种方法对于解决青少年的Sti流行至关重要。

项目成果

Workflow Analysis Driven Recommendations for Integration of Electronically-Enhanced Sexually Transmitted Infection Screening Tools in Pediatric Emergency Departments.

• DOI: 10.1007/s10916-020-01670-y
• 发表时间: 2020-11-10
• 期刊: Journal of medical systems
• 影响因子: 5.3
• 作者: Howe JL;Reed JL;Adams KT;Elsholz C;Augustine EM;Cruz AT;Mollen C;Pickett ML;Schmidt S;Stukus K;Ratwani RM;Goyal MK
• 通讯作者: Goyal MK