Development of a model to implement guideline-concordant STI/HIV healthcare and screening for adolescents in the pediatric emergency department

开发一个模型，对儿科急诊科的青少年实施符合指南的 STI/HIV 医疗保健和筛查

• 批准号: 10324017
• 负责人: Roland C Merchant
• 金额: $ 26.66万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-08 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10324017
• 关键词: 17 year old; Accident and Emergency department; Address; Adolescent; Adolescent sexual risk; Antibiotics; Area; Caring; Centers for Disease Control and Prevention (U.S.); Chlamydia; Chronic Disease; Clinic; Communities; Community Hospitals; Development; Diagnosis; Disease; Drug usage; Emergency Care; Evaluation; Female Adolescents; Future; Gonorrhea; Guidelines; HIV; Health; Healthcare; Hospitals; Human immunodeficiency virus test; Infection; Infertility; Measures; Modeling; New York City; Patient Care; Patients; Pediatric Hospitals; Pilot Projects; Prevention; Prevention Guidelines; Preventive service; Process; Process Measure; Recommendation; Research; Resources; Risk; Risk-Taking; Sexual Health; Sexual abuse; Sexually Transmitted Diseases; Syphilis; Testing; Trichomonas; United States; Vulnerable Populations; Work; acceptability and feasibility; adolescent patient; care providers; effectiveness evaluation; ethnic minority population; evaluation/testing; follow-up; health care delivery; high risk; implementation determinants; implementation strategy; improved; member; pediatric emergency; pre-exposure prophylaxis; preservation; racial minority; routine screening; screening; sexual minority; substance use; success; transmission process; urban dwelling; urgent care; working group

Project summary Adolescents (13-17 year-olds) in the United States (US) are at high risk of acquiring sexually transmitted infections/diseases (STIs), such as chlamydia, gonorrhea, and trichomonas, as well as HIV. Many adolescents who receive care in US pediatric emergency departments (PEDs) are diagnosed with or at risk for STIs and HIV, rendering PEDs a major venue for STI/HIV healthcare delivery and prevention in the US. However, previous research findings demonstrate that STI/HIV healthcare and screening provision in US PEDs is not concordant with guidelines from the Centers for Disease Control and Prevention (CDC). As a consequence, adolescents with or at-risk for STIs and HIV can develop adverse sequelae of undiagnosed or inadequately treated infections (e.g., infertility), and perpetuate the transmission of these infections. Assuring that adolescents receiving care in US PEDs obtain guideline-concordant healthcare for potential STIs and that at-risk adolescents are screened for STIs and HIV should assist in reducing the high rates of STIs and HIV among this vulnerable population. Providing guideline-concordant healthcare could also preserve their future health, as well as of their sexual and drug-using partners. Unfortunately, research is lacking on how guideline-concordant and recommended healthcare for adolescents at risk for or with suspected STIs/HIV can be implemented in PEDs. In this R21 project, we will address the deficit of research on implementation in US PEDs of guideline- concordant care of adolescents with suspected or who are at risk for STIs and HIV. With the assistance of community, hospital and PED stakeholders, we will identify determinants of providing guideline-concordant STI/HIV healthcare and screening to adolescents in a New York City (NYC) PED. Afterwards, we will select then pilot test implementation strategies to improve STI/HIV healthcare and screening provision. The product of this R21 will be a model of how to implement guideline-concordant STI/HIV care in a PED. In a subsequent R01-supported study, we will evaluate how the model can be implemented in other PEDs in the NYC area. This R21 project will proceed in three iterative aims using Implementation Mapping as a process framework. In Aim 1, we will assess determinants of the provision of guideline-concordant STI/HIV healthcare and screening for adolescents at the Mount Sinai Hospital PED using the Tailored Implementation in Chronic Diseases checklist. In Aim 2, we will select implementation strategies to address the determinants of the provision of guideline-concordant STI/HIV healthcare and screening for adolescents commensurate with the Mount Sinai Hospital PED’s capabilities and resources and the needs of its adolescent patients. In Aim 3, we will conduct a pilot study that evaluates the feasibility and acceptability of the implementation strategies selected in Aim 2 and will estimate their potential in increasing guideline-concordant STI/HIV healthcare and screening for adolescents.

项目摘要 美国的青少年（13-17岁）（美国）处于获得性传播的高风险 感染/疾病（STIS），例如衣原体，淋病和毛毛虫以及艾滋病毒。许多青少年 在美国儿科急诊科（PED）中接受护理的人被诊断出患有性传播感染或有风险 艾滋病毒，使PED是美国STI/HIV医疗保健提供和预防的主要场所。然而， 先前的研究结果表明，美国PED中的性病/艾滋病毒医疗保健和筛查规定不是 与疾病控制与预防中心（CDC）的指南一致。结果， 具有性传播感染和艾滋病毒风险或高危的青少年会出现未诊断或不充分的不良后遗症。 治疗的感染（例如不育），并使这些感染的传播永存。 确保在美国PED中接受护理的青少年获得指导方针，以确保潜在的医疗保健 性传播感染和高危青少年进行性传播感染和艾滋病毒应有助于降低性传播感染率 和艾滋病毒在这个脆弱的人群中。提供指南协议保健也可以保留 他们的未来健康以及他们的性和毒品伴侣。不幸的是，缺乏研究 指导原则如何对处于或怀疑性传播感染或艾滋病毒的风险或有可能的青少年推荐医疗保健 可以在PED中实现。 在这个R21项目中，我们将介绍美国准则实施研究的辩护 - 对有疑问或有传性传播感染风险的青少年的一致护理。在协助下 社区，医院和PED利益相关者，我们将确定提供准则协议的决定者 STI/HIV医疗保健和对纽约市（NYC）PED的青少年进行筛查。之后，我们将选择 然后，试点测试实施策略，以改善STI/HIV医疗保健和筛查提供。产品 R21中将是如何在PED中实施指导条件的STI/HIV护理的模型。在随后的序列中 R01支持的研究，我们将评估该模型如何在纽约市区的其他PED中实施。 该R21项目将以实施映射作为过程框架进行三个迭代目标进行。 在AIM 1中，我们将评估提供指南的确定词，并确定性STI/HIV Healthcare和 使用慢性实施的量身定制的实施，对西奈山医院的青少年进行筛查 疾病清单。在AIM 2中，我们将选择实施策略来解决 提供指导方针的性传播感染/艾滋病毒医疗保健和对青少年的筛查 西奈山医院PED的能力和资源及其青春期患者的需求。在AIM 3中，我们 将进行一项试点研究，以评估实施策略的可行性和可接受性 在AIM 2中选出，并将估算其潜力，以提高指导条款/艾滋病毒医疗保健和 筛选青少年。