Using Clinical Design Support to Improve Child Physical Abuse Testing

 描述（由申请人提供）：这个职业发展奖支持丹尼尔林德伯格医学博士发展成为一个独立的调查员，专注于儿童身体虐待的早期识别。通过这个K23奖项，林德伯格博士将获得指导经验，以开发基于电子健康记录的工具，帮助医生改善他们对身体虐待儿童的测试决定。这些工具将提高对最佳实践指南的遵守;这样做，它们将提高滥用识别，降低可避免的测试的成本和风险，并减少因种族和经济因素而产生的变异性。该提案的职业发展目标是让Lindberg博士发展信息学和传播与实施科学方面的技能。这些技能将为独立的研究生涯奠定基础，将该领域内的最佳证据转化为照顾受虐待儿童的大型医生社区。 本申请中建议的辅导活动将遵循3个核心目标。首先，林德伯格博士将使用调查和焦点小组来确定那些被医生认为对质量改进具有最高优先级的指南。在这个目标中，他将确定决策支持工具最有可能改善测试决策的工作流模式。接下来，他将设计临床决策支持工具，并确保它们能够在3个独立的临床环境中使用。最后，他将测试这些工具的能力，以提高医生遵守指南，并进一步提高滥用识别和减少实践的变化。 林德伯格博士是一名初级调查员-急诊医生和儿童虐待专家，迄今为止，他的研究经验涉及儿童虐待医生对虐待测试的观察性研究。这些先前的研究有助于了解滥用测试的最佳做法，但缺乏强有力的传播和实施工作，限制了它们对更广泛领域的影响。 林德伯格博士组建了一个强大的导师团队来监督拟议研究的核心领域。主要导师是德斯蒙德·鲁扬博士，他将监督林德伯格博士职业发展的儿童虐待和干预研究方面。作为罗伯特·伍德约翰逊基金会临床学者项目的国家项目主任和LONGSCAN网络的首席研究员，Runyan博士是全国首屈一指的虐待儿童研究人员之一，也是初级研究人员的经验丰富的导师。罗素格拉斯哥博士将担任共同导师，主要负责指导该提案的传播和实施部分。作为RE-AIM传播和实施框架的主要开发者，格拉斯哥博士在资助研究方面有着良好的记录，并成功地指导了几位初级研究人员。最后，Lalit Bajaj博士将担任共同导师，主要负责指导提案的信息学部分。作为科罗拉多儿童医院临床研究组织的医学主任和儿科急诊医学PECARN网络的积极贡献者，Bajaj博士是临床信息学领域的领导者，是确保成功完成本提案信息学部分的理想人选。 大学内 在科罗拉多医学院，林德伯格博士将有机会获得研究生课程，研讨会，最重要的是，指导经验，以完成拟议的研究。作为全国领先的联邦资助研究中心之一，林德伯格博士将有机会获得所有必要的工具，以完成研究和职业发展活动。除了强大的临床信息学基础设施外，该大学还拥有Kempe中心，用于预防和治疗虐待儿童和儿童虐待，这是全国领先的，全面的受虐儿童护理中心之一。

 DESCRIPTION (provided by applicant): This career development award supports the development of Daniel Lindberg MD into an independent investigator focused on the early recognition of child physical abuse. Through this K23 award, Dr. Lindberg will gain mentored experience to develop tools based in the electronic health record that help doctors improve their testing decisions for children with concern for physical abuse. These tools will improve adherence with best- practice guidelines; in so doing, they will improve abuse recognition, reduce the costs and risks of avoidable testing, and decrease variability according to race and economic factors. The career development goals of this proposal are to allow Dr. Lindberg to develop skills in informatics and dissemination & implementation science. These skills will provide the foundation for an independent research career that will translate the best evidence within the field to the large community of physicians who care for abused children. The mentored activities proposed in this application will follow 3 core aims. First, Dr. Lindberg will use surveys and focus groups to identify those guidelines that are perceived by doctors to have the highest priority for quality improvement. In this aim, he will determine the workflow patterns where decision support tools are most likely to improve testing decisions. Next, he will design the clinical decision support tools and ensure that they are able to be used in 3, separate clinica environments. Finally, he will test the ability of these tools to improve guideline adherence by physicians, and further to improve abuse recognition and decrease practice variation. Dr. Lindberg is a junior investigator - an emergency physician and child abuse specialist whose research experience to date has dealt with observational studies of abuse testing by child abuse physicians. These prior studies have contributed to the understanding of best practices for abuse testing, but the lack of robust dissemination and implementation work has limited their effect on the broader field. Dr. Lindberg has assembled a strong team of mentors to supervise the core areas of the proposed research. The primary mentor is Dr. Desmond Runyan, who will supervise the child abuse and interventional research aspects of Dr. Lindberg's career development. As the National Program Director for the Robert Wood Johnson Foundation's Clinical Scholars Program, and the Principal Investigator of the LONGSCAN network, Dr. Runyan is one of the nation's premier child abuse researchers and an experienced mentor of junior investigators. Dr. Russell Glasgow will serve as co-mentor with primary responsibility for guiding the dissemination and implementation portions of the proposal. As the primary developer of the RE-AIM framework for dissemination and implementation, Dr. Glasgow has a strong record of funded research and has successfully mentored several junior investigators. Finally, Dr. Lalit Bajaj will serve as co-mentor, with primary responsibility for guiding the informatics portions of the proposal. As the medical director of the Children's Hospital Colorado Clinical Research Organization and an active contributor to the PECARN network for pediatric emergency medicine, Dr. Bajaj is a leader in the field of clinical informatics, and the ideal mento to ensure successful completion of the informatics portion of this proposal. Within the University of Colorado School of Medicine, Dr. Lindberg will have access to graduate courses, seminars and most importantly, mentored experience to complete the proposed research. As one of the nation's leading centers for federally funded research, Dr. Lindberg will have access to all necessary tools to complete research and career development activities. In addition to a robust infrastructure for clinical informatics, the University boasts the Kempe Center for the prevention and treatment of Child Abuse and Neglect, one of the nation's leading, comprehensive centers for the care of abused children.