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

项目总结： 性传播感染(STI)在青少年中非常普遍。尽管有既定的原则 对于性传播感染的控制，与性传播感染的筛查和诊断、治疗和预防有关的临床实践包括 青少年处于次优状态。迫切需要将我们的筛查计划扩大到非传统的 医疗机构，如急诊科(ED)，帮助那些原本不能接触到的青少年 接受预防性保健，并确定提供这一服务的最有效和最具成本效益的方法 放映。此应用程序的目标是利用我们从基于ED的单中心获得的最新见解 青少年淋病和衣原体筛查研究及其在全国儿科教育中的应用 研究网络，以确定临床上最有效和最具成本效益的筛查方法 当青少年通过务实的试验被实施到现实世界的临床环境中时。这将是 通过儿童医院急诊室网络完成，并有良好的研究合作记录 (儿科急救应用研究网络或PECARN)。这项研究将有助于 创建临床有效、经济高效和可持续的GC/CT筛查计划的证据基础 可以成功地实施到急诊室的临床工作流程中。它还将提高对糖尿病的诊断 无症状性传播感染，缩短治疗间隔时间，从而降低再感染率 传播和总体的性传播感染负担，以及降低医疗成本。这一干预将依赖于 一种电子集成患者报告数据以指导临床决策支持的创新方法。 这项工作意义重大，因为它有可能将当前的ED临床实践范例从 急性卫生遇到参与更广泛的公共卫生管理，它将填补 需要文献为淋病和衣原体筛查的最佳方法提供证据 布景。首先，我们将应用人的因素建模方法来执行每个ED工作流评估 参与儿科急诊室，以确定将筛查过程融入日常生活的最有效方式 临床护理。在这些分析之后，我们将进行一项比较有效性的语用试验 性传播感染筛查(仅筛查那些披露高危性行为的人)与普遍提供的性传播感染 通过电子集成患者报告数据进行筛查(向所有人提供，不考虑风险)以供提供 临床决策支持。然后我们将开发决策分析模型来评估以下项目的成本效益 有针对性的筛查与普遍提供的筛查相比。这项研究是新颖的，因为它改变了通常的 ED中的临床实践范式--从有症状的青少年STI诊断到STI筛查和 预防，这是解决青少年中性传播感染流行病的关键办法。

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.