Improving Child Psychiatrists' Clinical Decision-Making

描述(由申请者提供)：该K-奖旨在培养成为儿童和青少年精神病学家(CAPS)临床决策研究的独立调查员的专业知识。这一领域是至关重要的，因为在诊断方面，CAP之间存在差异，导致适当治疗的延误和不适当治疗的不同影响。这些问题被发现在多种情况下都会发生，诊断范围很广，比如注意力缺陷多动障碍(ADHD)和青少年双相情感障碍(JBD)。令人惊讶的是，几乎没有人进行研究来了解和改善CAPS的行为，但工具已经被用于医学的其他领域，以表征和改善临床医生的行为。判断和决策(JDM)研究描述了临床医生如何评估和权衡症状，得出诊断和治疗。调查人员已经创造了有效的工具来改进这些过程。这位候选人的长期目标是将JDM方法应用于一系列儿童精神病理学。在这个奖项中，她将利用她在儿童疾病诊断和治疗方面的研究经验，专注于ADHD和JBD的诊断。她将实现K奖的三个目标：i)培训成为JDM精神病学的独立研究员，以描述和改进CAP的临床实践；ii)应用JDM描述CAPS如何对患有JBD、ADHD和共病障碍的儿童做出诊断决策，iii)利用这些结果帮助开发和试点以人为中心的诊断决策辅助工具(DDA)，以提高诊断准确性，为R01将研究其在对照研究中的使用做准备。后续研究将把JDM应用于其他诊断和治疗问题。

DESCRIPTION (provided by applicant): This K-Award is designed to develop expertise for becoming an independent investigator in the study of clinical decision-making of child and adolescent psychiatrists (CAPs). This area is critical because of the demonstrated variability between CAPs regarding diagnosis leading to delays in appropriate treatment and diverse effects from inappropriate treatment. These problems have been found to occur in multiple settings with a range of diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD) and Juvenile Bipolar Disorder (JBD). Surprisingly little research has been done to understand and improve CAPs' behavior, yet tools have been used in other areas of medicine to characterize and improve clinician behavior. Judgment and decision-making (JDM) studies have described how clinicians evaluate and weigh symptoms, arrive at a diagnosis and treatment. Investigators have created effective tools to improve these processes. The candidate's long-term goal is to apply JDM methods to a range of childhood psychopathology. For this award she will focus on the diagnosis of ADHD and JBD drawing on her experience in research on the diagnosis and treatment of childhood disorders. She will accomplish the goals of the K-award with 3 aims: i) To train to be an independent investigator in JDM in psychiatry in order to describe and improve the clinical practices of CAP; ii) To apply JDM to describe how CAPs make diagnostic decisions with children with JBD, ADHD, and comorbid disorders, iii) To use these results to help develop and pilot a human-centered diagnostic decision aid (DDA) to improve diagnostic accuracy in preparation for an R01 which will study its use in controlled studies. Subsequent research will apply JDM to other diagnostic and treatment issues.