Improving adolescent health outcomes through preventive care transformation

项目摘要 青少年的预防保健对于最大限度地提高他们的健康和福祉至关重要[1]。 不幸的是，儿科初级保健经常不能满足青少年的预防需求， 这一点在这一人群中表现得尤为突出[2]。 在这项拨款申请中，我们建议将现有的社区发展支援计划扩展至青少年基层医疗服务， 实施一个全面的，发展适当的，筛选和医生的目的， 决策支持过程。我们的研究小组先前完成的工作已经证明了使用 CDSS实施和评估临床指南[5，6]。我们力求积极影响 预防性初级保健访问，将以前的成功应用于我们的青少年实践。我们假设 使用平板电脑技术，实施适合发展的普遍筛查做法， 并加强医生对所有年度青少年临床相关指南的决策支持 预防性保健访问将导致更好的健康结果，包括更高的坚持医生的比例， 建议和改善患者功能。 本提案的具体研究目标是： 目标1：扩大和修改现有的儿童发展支助系统，以纳入青少年预防保健单元 包括适合11至21岁青少年发育的筛查工具 为医生量身定制的循证临床决策支持。 目标2：评价青少年预防保健单元对查明 青少年小学生特定的精神和身体健康问题及治疗结果 卫生保健设置。 该项目关注的青少年初级保健问题包括性传播感染， 抑郁症，物质使用和人类乳头瘤病毒（HPV）免疫接种。我们希望这个项目能有所改善 青少年的健康结果，指导未来努力实施普遍筛查和CDSS， 各种初级保健环境，并提供额外的证据，以支持广泛的电子筛查 以及用于预防保健的计算机化决策支持，作为改善青少年健康的方法。 关键词：青少年;筛查;初级保健;计算机决策支持系统

Project Abstract Preventive care for adolescents is vitally important for maximizing their health and well-being[1]. Unfortunately, pediatric primary care frequently fails to meet the preventive needs of adolescents as demonstrated by poor health outcomes for this population [2]. In this grant application, we propose to expand an existing CDSS into our adolescent primary care practices for the purpose of implementing a comprehensive, and developmentally appropriate, screening and physician decision support process. Prior work completed by our research group has demonstrated the feasibility of using CDSS to implement and evaluate clinical guidelines [5, 6]. We seek to positively impact the effectiveness of preventative primary care visits by applying this previous success to our adolescent practice. We hypothesize that the implementation of developmentally appropriate universal screening practices, using tablet technology, and enhanced physician decision support regarding clinically relevant guidelines for all annual adolescent preventive care visits will result in better health outcomes, including higher rates of adherence to physician recommendations and improved patient functioning. The specific research aims of this proposal are: Aim 1: Expand and modify an existing CDSS to include an Adolescent Preventive Care Module comprised of developmentally appropriate screening tools for adolescents aged 11 to 21 years and tailored evidence-based clinical decision support for physicians. Aim 2: Evaluate the impact of the Adolescent Preventive Care Module on the identification of specific mental and physical health problems and treatment outcomes in an adolescent primary health care setting. Adolescent primary care issues of interest for this project include sexually transmitted infection (STI), depression, substance use and Human Papillomavirus (HPV) immunization. We expect this project to improve the health outcomes of adolescents, guide future efforts to implement universal screening and CDSS in a variety of primary care settings, and provide additional evidence to support broad-based electronic screening and computerized decision support for use in preventive care as a method for improving adolescent health. Keywords: Adolescent; Screening; Primary Care; Computer Decision Support Systems