Improving Pediatric Developmental Screening and Communications: A CME

描述(由申请人提供)：发育迟缓在儿童早期很常见，影响至少10%的儿童，是以后发育状况的标志。众所周知，大脑在生命的头三年具有巨大的适应性，这意味着对延迟的早期治疗会带来更好的结果，而后来的干预则不那么有效。为了提供治疗以改善儿童的预后，及早识别生命头三年的延迟和感觉障碍至关重要。儿童健康的主要组织对这一专题的广泛关注证明了对早期识别有发育问题风险的儿童的巨大需求和兴趣(AAP建议、NICHD对有智力迟滞风险的婴幼儿的早期识别和干预、以及AHRQ关于诊断错误研究的特别强调通知)。一个一贯的关切是，需要在不同的受众中制定筛查战略，并将有效的、基于证据的筛查方法转化为用于初级保健实践的方法。有许多不同的筛查工具可用，但对于哪些筛查在实践中最好使用还没有达成共识。然而，筛查越来越多地被从业者采用，将结果转嫁给父母的情况很不舒服。因此，有必要编写教育材料，汇集信息，帮助初级保健提供者选择最佳工具；提供关于在实践中实施筛查的指导；并在实践中宣传这些筛查的目的和结果。这一资源将使提供者了解开展发育性筛查的重要性和挑战；协助提供者理解这些结果并将其传达给父母，并确定和承认筛查战略和结果交付方面的文化差异。具体目标是：目标1：为CME/CE计划制定临床内容大纲，重点放在两个主要领域：1)了解和适当实施初级保健中的发育筛查。2)加强与家长沟通发育筛查试验的目的和结果。目标2：为基于Web的继续医学教育/CE课程的原型模块开发临床内容/互动性。目标3：开发一种独特的方法，通过基于视频的讲故事小插曲在网络上学习。这个在线的继续医学教育项目将通过儿科医生和父母处理过此类问题(用他们自己的话)的“真实世界”故事来讲述。本课程将说明将结果传达给家长并寻求适当的下一步护理措施的技巧。因为捕捉高质量的视频是此类项目的核心成本部分，我们还建议使用这些视频为家长创建一个网站。目标4：进行一系列定性访谈，了解课程发展情况并对课程进行评估。 公共卫生相关性：在这个第一阶段的计划中，我们将开发一个基于CME/CE网络课程的原型，以帮助医疗保健提供者了解发育筛查的目的和方法，并更有效地与家长交流结果。该计划将汇集现有的研究，并为儿科医生的筛查提供一个容易获得的来源。通过现有媒介提供创新内容，我们的目标是通过这一产品接触到面临这一重要问题的初级保健提供者，以通过早期识别和干预来改善结果。

DESCRIPTION (provided by applicant): Developmental delays are common in early childhood, affecting at least 10 percent of children and are markers for later developmental conditions. It is well established that the tremendous adaptability of the brain in the first three years of life means that early treatment of delays leads to improved outcomes, whereas later intervention is less effective. In order to provide treatment to improve children's outcomes, early identification of delays and sensory impairments during the first three years of life are critical. There is a tremendous need for and interest in early identification of children at risk for development problems, as is evidenced by the vast attention to this topic by the leading organizations for pediatric health (AAP recommendations, NICHD's Early Identification and Interventions for Infants and Young Children at Risk for Mental Retardation, and AHRQ Special Emphasis Notice for research on diagnostic errors). A consistent concern is that there is the need for screening strategies in diverse audiences, and for translating effective, evidence-based screening approaches for use in primary care practices. There are a number of different screening tools available, but no consensus on which screens are best used in practice. However, screening is being increasingly adopted by practitioners and there is a high level of discomfort translating the results to parents. Thus, there is a need for educational materials that brings together information to assist primary care providers in choosing the best tools; provides guidance on implementation of screening in practice; and communicates the purpose and results of these screens in practice. This resource will inform providers about the importance and challenges of conducting developmental screening; assist providers in understanding and communicating those results to parents, and identifying and acknowledging cultural differences in screening strategies and delivery of results. The specific aims are: Aim 1: To develop a clinical content outline for a CME/CE program that will focus on two major areas: 1) Understanding and appropriate implementation of development screeners in primary care. 2) Improving communication of the purpose and results of developmental screening tests with parents. Aim 2: Develop clinical content/interactivity for a prototype module of the Web-based CME/CE course. Aim 3: Develop a unique approach to learning on the web through video-based storytelling vignettes. This online CME program will speak through "real world" stories of pediatricians and parents who have dealt with such issues (in their own words). The course will illustrate techniques for communicating results to parents and seeking appropriate next steps for care. Because capturing high quality video is a core cost component of such a program, we also propose to use the video to create a web site for parents. Aim 4: Conduct a set of qualitative interviews to inform development and evaluate the course. PUBLIC HEALTH RELEVANCE: In this Phase I program we will develop a prototype of a CME/CE Web-based course to assist health care providers understand the purpose and approach to developmental screening, and more effectively communicate results with parents. This program will bring together existing research and provide an easily accessible source for pediatricians on screening. By providing innovative content via an established medium, we aim, through this product, to reach primary care providers facing this important issue to improve outcomes through early identification and intervention.