Translating Evidence-Based Developmental Screening into Pediatric Primary Care

描述（由申请人提供）：儿童早期的发育问题很常见，往往未被发现，导致严重残疾。使用标准化工具进行发育筛查可以改善发育迟缓的检测，并允许转诊到早期干预服务。不幸的是，很少有临床医生使用标准化的筛查工具来识别发育问题。美国儿科学会（AAP）最近发布了一项建议，即医疗保健提供者在所有健康儿童就诊时进行发育监测，并在9、18和30个月大时进行发育筛查。该应用程序将解决AAP的循证政策声明的适应性，可行性和有效性， 在城市初级保健环境中进行发育筛查，主要服务于低收入的非洲裔美国家庭。本申请的具体目的是（1）确定在初级保健实践中使用基于指南的标准化发育筛查的障碍和促进因素，（2）评估与对照条件相比实施两种不同发育筛查方案的可行性：在9、18和30个月时进行标准化发育筛查，支持方案的实施（干预1）与第9、18和30个月时的标准化发育筛查，没有额外的方案实施支持（干预2）与单独的发育监测（对照条件），和（3）确定两种不同发育筛选方案与对照条件相比的相对有效性：在9、18和30个月时进行标准化发育筛查，支持方案的实施（干预1）与9岁、18岁时的标准化发育筛查，和30个月，没有额外的支持方案的实施（干预2）与单独的发育监测（对照条件）。该应用程序将采用混合方法研究设计，结合定性和定量方法。在申请的第一年，将招募一家大型儿童医院附属的城市初级保健儿科实践。将对参与实践的卫生保健提供者和办公室工作人员进行重点小组调查，以确定态度、社会规范和感知的行为控制，包括发育筛查的促进因素和障碍。从这些会议上获得的信息将用于调整实施的发展筛选协议。在申请的第2-3年，医疗保健提供者将被随机分配到三种发育筛查方案中的一种：初级保健支持人员的靶向筛查，医疗保健提供者的靶向筛查或单独监测。符合条件的儿童将接受为期18个月的干预随访，并将从电子健康记录和早期干预服务提供者那里获得有关发育问题的识别和转诊以及早期干预登记的结果数据。将对参与的卫生保健提供者和家庭进行调查，以获得有关各种筛查方案可行性的信息。

DESCRIPTION (provided by the applicant): Developmental problems in early childhood are common and often go undetected, leading to significant disability. Developmental screening using standardized instruments can improve the detection of developmental delays and allow for referral to early intervention services. Unfortunately, few clinicians utilize standardized screening instruments to identify developmental problems. The American Academy of Pediatrics (AAP) recently issued a recommendation that health care providers conduct developmental surveillance at all well child visits and institute developmental screening at 9, 18, and 30 months of age. This application will address the adaptability, feasibility, and effectiveness of the AAP's evidence-based policy statement regarding developmental screening in an urban primary care setting serving primarily low income African American families. The specific aims of this application are (1) to identify barriers and facilitators to the use of guideline based standardized developmental screening in primary care practice, (2) to assess the feasibility of implementation of two different developmental screening protocols compared with a control condition: standardized developmental screening at 9, 18, and 30 months with support for the implementation of the protocol (Intervention 1) vs. standardized developmental screening at 9, 18, and 30 months with no additional support for the implementation of the protocol (Intervention 2) vs. developmental surveillance alone (control condition), and (3) to determine the relative effectiveness of two different developmental screening protocols compared with a control condition: standardized developmental screening at 9, 18, and 30 months with support for the implementation of the protocol (Intervention 1) vs. standardized developmental screening at 9, 18, and 30 months with no additional support for the implementation of the protocol (Intervention 2) vs. developmental surveillance alone (control condition). The application will employ a mixed methods study design that combines qualitative and quantitative methodologies. In year 1 of the application, urban primary care pediatric practices affiliated with a large children's hospital will be recruited. Focus groups of health care providers and office staff at participating practices will be conducted to identify attitudes, social norms, and perceived behavioral controls including facilitators and barriers to developmental screening. Information obtained from these meetings will be used to adapt a developmental screening protocol for implementation. In years 2-3 of the application, health care providers will be randomized to one of three developmental screening protocols: targeted screening by primary care support staff, targeted screening by health care providers, or surveillance alone. Eligible children will be followed in the intervention for 18 months, and outcome data on identification and referral of developmental problems and enrollment in early intervention will be obtained from electronic health records and early intervention service providers. Surveys of participating health care providers and families will be used to obtain information on the feasibility of the various screening protocols.