Developing a Strategic Approach to Management of Adolescents with PID

描述(由申请人提供)：盆腔炎性疾病是一种常见的生殖健康疾病，对青少年和少数族裔妇女的影响不成比例，并使受影响的患者面临宫外孕、慢性盆腔疼痛和不孕不育的风险。有效的口服抗生素方案的可获得性和门诊疗效试验的阳性结果导致了我们的治疗方法转向门诊治疗。最近一项使用疗效试验数据和比较管理策略的成本效益分析支持这一转变。然而，对于如何有效地将这些发现转化为对青春期女孩的照顾，文献一直相对沉默。如果公共卫生专业人员和青少年保健提供者未能在功效试验中考虑到与成年妇女相比，参加试验对青春期女孩坚持治疗的不同影响，并且缺乏针对青春期独特方面的已发表的决策模型，则这些研究对青春期女孩管理的相关性将受到限制。作为一名发展中的公共卫生临床医生兼科学家，我一直专注于改善青少年的产后护理。虽然我有公共卫生硕士学位，并发表了22篇文章和章节，但我需要额外的公共卫生培训，才能在我的研究领域迈出符合逻辑的下一步。这个职业发展项目的主要培训目标是扩大我使用决策分析和卫生经济学原理设计、实施和评估公共卫生干预措施的能力，并发展将消费者价值纳入STI干预计划的成本效益分析的能力。本研究的目的是：1)利用条件价值评估方法(CVM)，探索综合的、适合青少年发展需要的治疗方案的护理偏好、成本措施和可接受的替代方案；2)建立一个成本-效益模型，该模型包含了青少年特有的效用，以确定替代干预所需的有效性阈值。父母、青少年和临床医生将从STI高发社区招募参与CVM研究。利用已发表的青少年特定结果参数和CVM研究定义的效用，将开发一个经济决策模型，以经验地定义患有PID的青少年临床管理的战略方法。这项工作有可能澄清成人疗效试验和以社会为中心的经济分析的结果，从而改善受这种疾病影响的青少年的护理质量和健康结果。它还将产生关于患者偏好的初步数据，这些数据可以导致设计替代门诊干预措施，这些干预措施的成本低于住院治疗，但消费者(青春期女孩及其父母)和PID临床服务提供者可以接受。

DESCRIPTION (provided by applicant): Pelvic inflammatory disease (PID) is a common reproductive health disorder that disproportionately affects adolescent and minority women and puts the affected patient at risk for ectopic pregnancy, chronic pelvic pain, and infertility. The availability of effective oral antibiotic regimens and positive findings from an outpatient efficacy trial have resulted in a shift in our approach to treatment towards outpatient therapy. A recent cost-effectiveness analysis using the efficacy trial data and comparing management strategies supports this shift. The literature, however, has been relatively silent on how to effectively translate these findings to the care of the adolescent girl. If public health professionals and health providers for adolescents fail to consider the differential effects of trial participation on adolescent girls' adherence to therapy compared to adult women in the efficacy trial and the lack of published decision models tailored to the unique aspects of adolescence, the relevance of these studies to the management of adolescent girls will be limited. As a developing public health clinician-scientist, I have focused on improving PID care for adolescents. Although I have a MPH and have published 22 articles and chapters, I need additional public health training to take the next logical step in my line of research. The primary training aims of this career development project are to expand my ability to design, implement, and evaluate public health interventions using the tenets of decision-analysis and health economics, and to develop the capacity to incorporate consumer values into cost-benefit analyses of STI intervention programs. The research aims are 1) to explore the care preferences, measures of cost, and acceptable alternatives for comprehensive and developmentally-appropriate care for adolescents with PID using contingent valuation methods(CVM); and 2) to create a cost-benefit model that incorporates adolescent-specific utilities to determine he thresholds for effectiveness that would be required for alternative interventions. Parents, adolescents, and clinicians will be recruited from high STI prevalence communities to participate in the CVM study. Using published adolescent-specific outcome parameters and the utilities defined by the CVM study, an economic decision model will be developed to empirically define a strategic approach to clinical management of the adolescent with PID. This work has the potential to clarify the results from adult efficacy trials and society-focused economic analyses, resulting in improved quality of care and health outcomes for adolescents affected by the disorder. It will also yield preliminary data on patient preferences that can lead to the design of alternative outpatient interventions that are less costly than inpatient therapy, but are acceptable to the consumers adolescent girls and their parents) and providers of PID clinical services.