SHARED DECISION-MAKING AND INAPPROPRIATE ANTIBIOTIC USE

这项提案要求支持伊丽莎白·考克斯博士成为医患沟通领域的独立研究员的导师临床科学家奖(K08)，重点是利用共同决策来提高儿童护理质量。这一奖项将促进考克斯博士在临床环境中获得人际沟通科学方面的高级研究能力。拟议的培训计划将包括完成人口健康博士学位，在医疗互动期间分析沟通方面的培训，以及个人和小组指导。威斯康星大学为这项拟议的工作提供了一个理想的环境，因为它提供了接触到话语分析(Mary Anne Fitzpatrick博士)、医生满意度(Mark Linzer博士)和女性研究人员(Molly Carnes博士)指导方面的知名研究人员的途径。约翰·霍普金斯大学的黛布拉·罗特博士将提供医患交流分析方面的指导。考克斯博士还得到了人口健康科学部和妇女健康研究中心的大力支持，考克斯博士将参加华盛顿大学临床研究人员预备路径(NIH K30)，该路径确保了在统计、研究设计、研究伦理、管理/领导力和科学写作等核心领域的能力。在这一培训拨款期间，考克斯博士将开发和验证一种工具，以衡量儿科初级保健中的共同决策。然后，这一工具将用于一项横断面研究，以检查共同决策与儿童上呼吸道感染护理结果质量的关系。候选人假设，在上呼吸道感染的急性初级保健就诊中分享决策将减少不适当的抗生素处方，同时为父母和患者提供满意度。这项拟议的研究带来了多学科方法的优势，以解决儿童护理中常见的临床问题。共享决策对各种急慢性医疗问题具有广泛的适用性。如果证明有效，在这种临床环境中使用共享决策将减少抗微生物耐药性，减少不良事件，降低护理成本，同时保持就诊满意度。

This proposal requests support for a Mentored Clinical Scientist Award (K08) for Dr. Elizabeth Cox to become an independent researcher in the field of doctor-patient communication, with a focus on the use of shared decision-making to improve quality of care for children. This award will facilitate Dr. Cox's acquisition of advanced research competencies in the science of interpersonal communication in clinical settings. The proposed training program will include completion of a Ph.D. in Population Health, training in analysis of communication during medical interactions, as well as both individual and group mentoring. The University of Wisconsin offers an ideal environment for the proposed work because it provides access to renowned researchers in discourse analysis (Dr. Mary Anne Fitzpatrick), physician satisfaction (Dr. Mark Linzer) and mentoring of women researchers (Drs. Molly Carnes). Dr. Debra Roter (The Johns Hopkins University) will provide mentoring in the analysis of physician-patient communication. Dr. Cox also has strong support from the Department of Population Health Science and the Center for Women's Health Research, Dr. Cox will participate in the UW Clinical Investigator Preparatory Pathway (NIH K30), which assures competency in core areas of statistics, study design, research ethics, management/leadership, and scientific writing. During the period of this training grant, Dr. Cox will develop and validate an instrument to measure shared decision-making in pediatric primary care. This instrument will then be used in a cross-sectional study to examine the relationship of shared decision-making to quality of care outcomes for children's upper respiratory infection. The candidate hypothesizes that shared decision-making in acute primary care visits for upper respiratory infection will decrease inappropriate antibiotic prescribing, while providing satisfaction for both the parent and patient. The proposed research brings the strengths of a multi-disciplinary approach to a common clinical problem in the care of children. Shared decision-making has wide applicability to a variety of acute and chronic healthcare problems. If proven effective, the use of shared decision- making in this clinical setting will result in decreased anti-microbial resistance, decreased adverse events, and decreased cost of care, while preserving visit satisfaction.