Systems Approach to Universal Teen Chlamydial Screening

普遍青少年衣原体筛查的系统方法

• 批准号: 6724616
• 负责人: MARY-ANN SHAFER
• 金额: $ 43.86万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2006-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6724616
• 关键词: Chlamydia trachomatis; adolescence (12-20); behavioral /social science research tag; chlamydial disease; clinical research; emergency health services; female; health care personnel performance; health care professional practice; health care service evaluation; health care service planning; health services research tag; human subject; mass screening; outcomes research; sex behavior; urinalysis

Background" C. trachomatis (CT) remains epidemic among sexually active adolescent females. Yet the goal of universal screening in the office setting has remained elusive even with the recent introduction of the non-invasive accurate urine based tests that eliminate the necessity of pelvic exams to obtain CT specimens. The long term goal of this TRIP I continuation proposal is to develop a Clinical Practice Intervention (CPI) that will increase CT screening of adolescent females at the point of care regardless of the reason for the visit. We have shown success with this CPI process applied to CT screening during health maintenance visits (HMV) which resulted in an increase from 5% screening at baseline to 65% post-CPl. During the course of our initial TRIP I work, we demonstrated that 2/3 of the target teens attended only same day/urgent care visits (UCVs) and were missed by the HMV focused CT screening. We propose to extend our work to meet the needs of these adolescents by providing CT screening in the urgent care setting. Aim: To significantly increase CT screening in sexually active adolescent females in the urgent care setting through the implementation of a new Clinical Practice Improvement intervention (CPI)that will facilitate the redesign of clinic systems to meet the unique demands of the adolescent and of the urgent care setting. HMO Setting and Population: Ten pediatric urgent care clinics will be selected from a large regional HMO of 34 clinics serving 97,000 females aged 14-18 years. Design/Methods" We will evaluate the effectiveness of the CPI-Urgent Care Intervention by randomizing 10 clinics to either the intervention or control group. The CPI-Urgent Care will consist of 1) engaging the leadership and staff; 2) building teams within clinic staff to accomplish the task; 3) re-designing clinical practice using rapid cycle quality improvement and "Plan-Do-Study-Act "cycles"; 4) sustaining the gains through the continuous monitoring the performance; and 5) developing new tools to improve the efficiency of CT screening in urgent care. This study includes a process evaluation component to evaluate how improvements are achieved and sustained over time. Analysis" Analysis will assess whether the changes in the proportions of sexually active adolescent females screened from baseline to post-intervention differ between the intervention and control clinics.

“沙眼原体（CT）在性活跃的青春期女性中仍然流行。然而，即使最近引入了无创准确的基于尿液的检查，消除了骨盆检查获得CT标本的必要性，在办公室环境中进行普遍筛查的目标仍然难以实现。这个TRIP I延续提案的长期目标是发展临床实践干预（CPI），在护理点增加对青少年女性的CT筛查，无论就诊原因如何。我们已经成功地将CPI过程应用于健康维护访问（HMV）期间的CT筛查，使筛查率从基线时的5%增加到cpl后的65%。在我们最初的TRIP I工作过程中，我们证明了2/3的目标青少年只参加了当天/紧急护理就诊（ucv），并被HMV重点CT筛查遗漏。我们建议延长