Improving the Detection of STIs in the Pediatric Emergency Department: A Pragmatic Trial

项目概要： 性传播感染在青少年中非常普遍。尽管有既定的原则 在性传播感染控制方面，与性传播感染的筛查和诊断、治疗和预防有关的临床实践， 青少年是次优的。有一个迫切需要扩大我们的筛查计划，以非传统的 卫生保健机构，如急诊室（艾德），以达到那些青少年谁，否则不会 获得预防性保健，并确定提供这种保健的最有效和最具成本效益的方法 筛选本申请的目标是利用我们最近从单中心ED获得的见解， 青少年淋病和衣原体筛查研究，并将其应用于全国儿科艾德 研究网络，以确定最临床有效和成本效益的筛查方法， 青少年时，实施到一个现实世界的临床环境，通过务实的试验。这将是 通过儿童医院急诊科网络完成，具有强大的研究合作记录 （Pediatric Emergency Care Applied Research Network或PECARN）这项研究将有助于 建立临床有效、经济有效和可持续的GC/CT筛查计划的证据基础， 可以成功地实施到急诊室的临床工作流程中。它还将改善 无症状性传播感染，缩短治疗间隔时间，从而降低 传播和总体性传播感染负担以及降低医疗保健费用。这种干预将依赖于 一种创新的方法，以电子方式整合患者报告的数据，以指导临床决策支持。 这项工作是重要的，因为它有可能改变目前的艾德临床实践范式，从只有 急性健康遭遇到参与更广泛的公共卫生管理，它将填补 需要文献为艾德中淋病和衣原体筛查的最佳方法提供证据 设置.首先，我们将应用人为因素建模方法来执行艾德工作流程评估， 参与儿科艾德，以确定最有效的方法，将筛查过程融入日常生活， 临床护理在这些分析之后，我们将进行一个比较有效的务实试验， STI筛查（仅筛查那些披露高风险性行为的人）与普遍提供的STI 通过电子整合患者报告的数据进行筛查（向所有人提供，无论风险如何） 临床决策支持。然后，我们将开发决策分析模型，以评估 与普遍提供的筛查相比，有针对性的筛查。这项研究是新颖的，因为它改变了通常的 艾德的临床实践范例，从有症状的青少年的STI诊断到STI筛查， 预防是解决青少年性传播感染问题的关键。

Project Summary: Sexually transmitted infections (STIs) are highly prevalent among adolescents. Despite established principles for STI control, clinical practices related to screening and diagnosis, treatment, and prevention of STIs among adolescents are suboptimal. There is an urgent need to expand our screening programs to nontraditional healthcare settings such as emergency departments (ED) to reach those adolescents who would otherwise not receive preventive healthcare, and to determine the most efficient and cost-effective method for providing this screening. The goal of this application is to leverage our recent insights obtained from single center ED-based adolescent gonorrhea and chlamydia screening research and apply them across a national pediatric ED research network to determine the most clinically effective and cost-effective screening approach for adolescents when implemented into a real-world clinical setting through a pragmatic trial. This will be accomplished through a network of children’s hospital EDs with a track record of robust research collaboration (Pediatric Emergency Care Applied Research Network or PECARN). This research will contribute to the evidence base for creating clinically effective, cost-effective, and sustainable GC/CT screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve diagnosis of asymptomatic STIs and decrease the time interval to treatment, consequently decreasing reinfection rates of transmission and the overall STI burden as well as decreasing healthcare costs. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide clinical decision support. This work is significant because it has the potential to shift current ED clinical practice paradigms from only acute health encounters to participation in the broader management of public health, and it will fill gaps in the literature needed to provide evidence for the best method of gonorrhea and chlamydia screening in an ED setting. First, we will apply human factors modeling methods to perform ED workflow evaluations at each participating pediatric ED to determine the most efficient way to integrate the screening process into everyday clinical care. Following these analyses, we will conduct a comparative effectiveness pragmatic trial of targeted STI screening (screening only those disclosing high risk sexual behavior) versus universally-offered STI screening (offered to all, regardless of risk) through electronic integration of patient reported data for provision of clinical decision support. We will then develop decision analytic models to evaluate the cost-effectiveness of targeted screening compared to universally offered screening. This research is novel in that it shifts the usual clinical practice paradigm in the ED from STI diagnosis in symptomatic adolescents to STI screening and prevention, an approach that is critical to addressing the STI epidemic among adolescents.