Clinical Decision Support to Promote Immigrant Child Health Screening

促进移民儿童健康筛查的临床决策支持

• 批准号: 10563211
• 负责人: Jeremy Michel
• 金额: $ 21.87万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-04 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10563211
• 关键词: Academy; Address; Adherence; American; Award; Awareness; Caring; Child; Child Care; Child Health; Childhood; Chronic Hepatitis B; Clinic; Clinical; Collaborations; Communicable Diseases; Communities; Country; Development; Diagnosis; Documentation; Electronic Health Record; Elements; Ensure; Familiarity; Family; Future; Geography; Guidelines; HIV; Health; Health Personnel; Health education; Health system; Healthcare; Helminths; Hepatitis B; Hepatitis B Infection; Human; Immigrant; Immigrant family; Institution; Intervention; Language; Learning; Malaria; Methods; Outcome; Parents; Patient Care; Patient-Focused Outcomes; Patients; Pediatric Hospitals; Pediatrics; Phase; Philadelphia; Physicians; Population; Primary Care; Primary carcinoma of the liver cells; Process; Provider; Published Comment; Recommendation; Refugees; Research; Resources; Schistosomiasis; Schools; Services; Soil; Standardization; Strongyloides stercoralis; Syphilis; Testing; Training; Translating; Tuberculosis; United States; Universities; Washington; Work; base; clinical center; clinical decision support; design; effectiveness evaluation; evidence base; evidence based guidelines; follow-up; high risk; implementation barriers; improved; low income country; lower income families; pediatrician; prevent; primary care clinic; primary care clinician; primary care practice; primary care provider; programs; safety net; screening; screening guidelines; tool; transmission process; usability; user centered design

Project Summary The majority of non-refugee immigrant children entering the US receive limited or no screening for infectious conditions. Delays in the diagnosis and treatment of infectious conditions in immigrant children can result in increased adverse patient outcomes and increased spread of communicable diseases. There is publically available, evidence-based guidance for clinicians in the form of an American Academy of Pediatrics’ (AAP) Immigrant Child Health Toolkit. However, most clinicians have only cursory familiarity with this resource or the needs of immigrant children. With the expansion of electronic health records (EHR) into primary care, one of the most promising strategies for increasing awareness of and standardizing infectious disease screening for immigrant child populations is the use of clinical decision support (CDS). CDS that is evidence-based, developed in concordance with local workflows, and tested by representative users is more likely to have a positive impact on patient care. CDS developed to be shareable holds great promise for reaching populations—like immigrant children—who are seen by a large number of geographically-dispersed health care providers, many of whom practice in safety- net settings where resources are more limited. The process of translating evidence into shareable CDS is still evolving, and this project will help to identify drivers and barriers to implementation of infectious disease screening recommendations. Involvement of multiple representative users during the design phase of CDS development can enhance acceptability and usability of CDS. Drs. Yun and Michel have developed a comprehensive plan for translating evidence-based recommendations for infectious disease screening during the care of immigrant children into shareable CDS. They build upon a previous collaboration to complete a similar task for refugee children. During this award period, they will apply user-centered design to create CDS based upon the American Academy of Pediatrics’ immigrant health screening recommendations and then confirm that this CDS meets the needs of diverse primary care providers and immigrant families through user-tests. For this project they will draw upon a broad user base including clinicians, immigrant families, and language services professionals in order to capture the functional requirements for CDS from numerous viewpoints. This rigorous implementation development and testing will support their planned submission of a follow up project to test the impact of this application on clinical outcomes and to support dissemination of this CDS broadly.

项目摘要 大多数进入美国的非难民移民儿童接受的传染病筛查有限或没有接受任何筛查 条件移民儿童感染性疾病诊断和治疗的延误可能导致 增加了病人的不良后果和增加了传染病的传播。有一种 以美国儿科学会（AAP）的形式为临床医生提供基于证据的指导 移民儿童健康工具包。然而，大多数临床医生只有粗略的熟悉这个资源或 移民儿童的需求。 随着电子健康记录（EHR）扩展到初级保健， 提高对移民儿童人群传染病筛查的认识并使其标准化， 使用临床决策支持（CDS）。以证据为基础的CDS，根据当地 工作流程，并由代表性用户进行测试，更有可能对患者护理产生积极影响。CDs 发展到可以分享的程度，对于接触到像移民儿童这样的人口来说， 看到了大量的地理分散的医疗保健提供者，其中许多人的做法是安全的- 网络环境下，资源更加有限。将证据转化为可共享CDS的过程仍在进行中。 该项目将有助于确定实施传染病防治战略的驱动因素和障碍， 筛选建议。CDS设计阶段多个代表性用户的参与 发展可以提高CDS的可接受性和可用性。 Drs. Yun和Michel制定了一项全面的计划来翻译基于证据的建议 在移民儿童的护理过程中进行传染病筛查。他们建立在一个 与此同时，她还与其他机构合作，为难民儿童完成类似的任务。在此奖励期间，他们将申请 以用户为中心的设计，根据美国儿科学会的移民健康状况创建CDS 筛选建议，然后确认该CDS满足不同初级保健提供者的需求 和移民家庭进行用户测试。对于这个项目，他们将利用广泛的用户基础，包括 临床医生，移民家庭和语言服务专业人员，以捕捉功能 从多个角度对CDS的要求。这种严格的实施开发和测试将 支持他们计划提交的后续项目，以测试本申请对临床的影响 并支持该CDS的广泛传播。