Systems Approach to Universal Teen Chlamydial Screening

背景“沙眼衣原体(CT)在性行为活跃的青春期女性中仍然流行。然而，即使最近推出了基于尿液的非侵入性准确测试，消除了获得CT样本的盆腔检查的必要性，在办公室环境中进行普遍筛查的目标仍然遥不可及。这次旅行I继续提案的长期目标是开发一种临床实践干预(CPI)，无论访问的原因如何，都将在护理点增加对青春期女性的CT筛查。我们已经将这一CPI过程成功地应用于健康维护就诊(HMV)期间的CT筛查，其结果是从基线的5%的筛查增加到CPL后的65%。在我工作的第一次旅行中，我们证明了2/3的目标青少年只参加了当天/紧急护理访问(UCV)，并且没有被HMV重点CT筛查所错过。我们建议延长 我们的工作是通过在紧急护理环境中提供CT筛查来满足这些青少年的需求。目的：通过实施新的临床实践改进干预(CPI)，显著增加紧急护理环境中性活跃的青春期女性的CT筛查，这将促进临床系统的重新设计，以满足青少年和紧急护理环境的独特需求。 卫生保健组织的环境和人口：将从34个大型地区性保健组织诊所中选出10个儿科紧急护理诊所，为97,000名14-18岁的女性提供服务。 设计/方法“我们将通过将10家诊所随机分为干预组和对照组来评估CPI-紧急护理干预的有效性。CPI-紧急护理将包括：1)动员领导和工作人员；2)在诊所工作人员中建立团队来完成任务；3)利用快速周期质量改进和”计划-做-研究-法案“周期来重新设计临床实践；4)通过持续监测绩效来维持成果；以及5)开发新的工具来提高紧急护理中CT筛查的效率。这项研究包括一个过程评估部分，用来评估如何随着时间的推移实现和维持改进。 分析“分析将评估从基线到干预后筛查性活跃的青春期女性比例的变化在干预诊所和对照诊所之间是否有所不同。

Background" C. trachomatis (CT) remains epidemic among sexually active adolescent females. Yet the goal of universal screening in the office setting has remained elusive even with the recent introduction of the non-invasive accurate urine based tests that eliminate the necessity of pelvic exams to obtain CT specimens. The long term goal of this TRIP I continuation proposal is to develop a Clinical Practice Intervention (CPI) that will increase CT screening of adolescent females at the point of care regardless of the reason for the visit. We have shown success with this CPI process applied to CT screening during health maintenance visits (HMV) which resulted in an increase from 5% screening at baseline to 65% post-CPl. During the course of our initial TRIP I work, we demonstrated that 2/3 of the target teens attended only same day/urgent care visits (UCVs) and were missed by the HMV focused CT screening. We propose to extend our work to meet the needs of these adolescents by providing CT screening in the urgent care setting. Aim: To significantly increase CT screening in sexually active adolescent females in the urgent care setting through the implementation of a new Clinical Practice Improvement intervention (CPI)that will facilitate the redesign of clinic systems to meet the unique demands of the adolescent and of the urgent care setting. HMO Setting and Population: Ten pediatric urgent care clinics will be selected from a large regional HMO of 34 clinics serving 97,000 females aged 14-18 years. Design/Methods" We will evaluate the effectiveness of the CPI-Urgent Care Intervention by randomizing 10 clinics to either the intervention or control group. The CPI-Urgent Care will consist of 1) engaging the leadership and staff; 2) building teams within clinic staff to accomplish the task; 3) re-designing clinical practice using rapid cycle quality improvement and "Plan-Do-Study-Act "cycles"; 4) sustaining the gains through the continuous monitoring the performance; and 5) developing new tools to improve the efficiency of CT screening in urgent care. This study includes a process evaluation component to evaluate how improvements are achieved and sustained over time. Analysis" Analysis will assess whether the changes in the proportions of sexually active adolescent females screened from baseline to post-intervention differ between the intervention and control clinics.