Development and Testing of an Intervention to Facilitate Shared Decision-Making in Pediatric Patients with Abdominal Pain Presenting to the Community Emergency Department Setting

开发和测试一种干预措施，以促进社区急诊科就诊的腹痛儿科患者共同决策

• 批准号: 10723374
• 负责人: Courtney W. Mangus
• 金额: $ 15.06万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723374
• 关键词: Development; Testing; Intervention; Facilitate; Shared

PROJECT SUMMARY ABSTRACT: Candidate: Dr. Courtney Mangus is a pediatric emergency medicine (EM) physician and health services researcher at the University of Michigan (U-M) Medical School. She is interested in identifying and testing ways to improve diagnostic safety and patient engagement via shared decision-making (SDM) in the community emergency department (ED) setting, which is under-resourced compared to tertiary care EDs. Her goal is to become an independent investigator and leader in the field, improving the quality of care for children evaluated for common pediatric conditions, such as abdominal pain, in community EDs. Research Context: The most common pediatric surgical emergency, appendicitis, is ideally diagnosed with ultrasonography. However, 85% of children seek care in community EDs, which often have limited resources. As such, children presenting with abdominal pain in this setting are more likely to undergo computed tomography (CT). CT imaging is the most sensitive diagnostic test for appendicitis, but it exposes children to ionizing radiation and ultimately increases their risk of developing cancer. Risk stratification tools exist to help clinicians determine which children with abdominal pain require imaging, but for the ~50% children in community EDs who fall into the group of intermediate risk for appendicitis, clinicians often face a dilemma regarding next diagnostic steps. Data suggest most clinicians choose either 1) CT imaging or 2) watchful waiting (observation or discharge with scheduled follow-up). Because this dilemma is so common, a systematic, family-centered approach is needed to communicate diagnostic options, including risks/benefits, and engage families in the decision-making process. Development and implementation of an intervention to facilitate SDM in this scenario has the potential to reduce unnecessary CT scans and increase family engagement in the diagnostic process. Research Aims: In this project, Dr. Mangus will utilize an iterative, user-centered design approach to develop and refine a risk- tailored intervention to facilitate SDM in the diagnosis of pediatric abdominal pain in the community ED setting (Aims 1a/1b) and pilot the intervention via a randomized controlled trial of 100 ED patients presenting with signs and symptoms of appendicitis to a community ED (Aim 2). The research will be conducted at Hurley Medical Center (HMC), a community hospital in Flint, Michigan, which serves a large population of racial/ethnic minority and low-income children (AHRQ priority populations). Career Development Plan: Dr. Mangus will undertake the proposed research plan under the expert mentorship of Drs. Mahajan, Manojlovich, Schoenfeld and Singh. Her career development curriculum is focused on mixed methods research, training in SDM intervention development, and clinical trial methodology. The proposal utilizes the resources of the U-M Department of EM, U-M’s Center for Bioethics and Social Sciences in Medicine, the U-M Institute for Healthcare Policy and Innovation, and HMC. In alignment with the mission of AHRQ, Dr. Mangus’ long-term goals are to improve patient-centered care and diagnostic safety for children requiring emergency care.

项目摘要： 候选人：Courtney Mangus博士是一名儿科急诊医学（EM）医生和卫生服务 密歇根大学医学院的研究员。她感兴趣的是确定和测试 通过社区共享决策（SDM）提高诊断安全性和患者参与度 急诊科（艾德）设置，与三级护理ED相比，资源不足。她的目标是 成为该领域的独立调查员和领导者，提高被评估儿童的护理质量 用于社区急诊室常见的儿科疾病，如腹痛。研究背景：最 常见的小儿外科急症，阑尾炎，是理想的诊断超声。然而，85% 的儿童在社区急诊室寻求护理，这些急诊室的资源往往有限。因此，儿童呈现 这种情况下的腹痛更可能接受计算机断层扫描（CT）。CT成像是最 敏感的诊断测试阑尾炎，但它暴露儿童电离辐射，并最终增加 患癌症的风险。存在风险分层工具，以帮助临床医生确定哪些儿童 腹痛需要影像学检查，但对于社区ED中约50%的儿童， 对于阑尾炎的中等风险，临床医生经常面临关于下一步诊断步骤的两难境地。数据表明 大多数临床医生选择1）CT成像或2）观察等待（观察或出院， 后续行动）。由于这种困境是如此普遍，需要一个系统的，以家庭为中心的方法， 沟通诊断选择，包括风险/益处，并让家庭参与决策过程。 在这种情况下，制定和执行一项促进可持续发展机制的干预措施有可能 减少不必要的CT扫描，增加家庭参与诊断过程。研究目的：在 在这个项目中，Mangus博士将利用一种迭代的、以用户为中心的设计方法来开发和完善一种风险评估方法， 在社区艾德环境中帮助SDM诊断小儿腹痛的定制干预措施 (Aims 1a/1b），并通过对100例艾德患者进行随机对照试验， 阑尾炎的体征和症状，以社区艾德（目标2）。这项研究将在赫尔利进行 医疗中心（HMC），密歇根州弗林特的一家社区医院，为大量种族/族裔人口提供服务。 少数民族和低收入儿童（AHRQ优先人群）。职业发展计划：Mangus博士将 在Mahajan、Manojlovich、Schoenfeld博士的专家指导下开展拟议的研究计划 还有辛格她的职业发展课程侧重于混合方法研究，SDM培训 干预开发和临床试验方法。该提案利用了密歇根大学的资源 密歇根大学医学生物伦理学和社会科学中心EM系，密歇根大学医学研究所 医疗保健政策和创新，以及HMC。根据AHRQ的使命，Mangus博士的长期 目标是改善以病人为中心的护理和需要紧急护理的儿童的诊断安全。