Occult Injury Screening and the Detection of Physical Abuse in Young Children

描述（由申请人提供）：该职业发展奖支持Joanne Wood， MD， MSHP作为一名专注于儿童虐待研究和提高虐待受害者护理质量的独立研究员的发展。通过K23奖，伍德博士将获得卫生服务研究方面的高级培训，并扩大她的技能，包括定性研究方法。申请中概述的职业发展目标将作为今后在虐待儿童领域进行调查的基础，包括卫生保健质量和成果研究以及质量基准。伍德博士提出了一项全面的研究计划，该计划将作为未来卫生服务研究和儿童虐待工作的基础。伍德博士的目标是开发、验证和应用隐匿性损伤筛查的质量指标，这是评估幼儿疑似身体虐待的关键组成部分。目标1将制定和验证年幼受伤儿童隐匿性损伤放射学筛查的适当标准。目标2将构建并验证一套算法，用于评估可应用于行政数据的隐匿性损伤筛查的适当性。目的3将比较各儿科医院隐匿性损伤筛查实践的质量。目标4将确定促进筛查的适当使用、过度使用和使用不足的因素。她的方法涉及使用定量和定性方法来解决识别和诊断滥用的局限性。Wood博士是一名初级调查员，在一家大型城市儿童医院接受过卫生政策研究方面的培训，在儿科和儿童虐待儿科方面拥有丰富的经验。她组建了一个优秀的多学科导师团队，由医学博士、MSCE（主要导师）David Rubin和医学博士、公共卫生硕士（共同导师）Chris Feudtner领导，指导她的职业发展。她的课程将包括正式的教学和通过使用定量和定性方法进行原创性研究而获得的实践经验。Wood博士将通过K23提案中提出的指导、高级培训和监督研究经验来提高她的工作质量和未来对该领域的贡献。费城儿童医院和宾夕法尼亚大学提供优秀的资源和指导，使伍德博士能够发展她的长期目标。她与许多部门和研究所的关系和熟悉程度将为整个卫生系统和整个大学的研究人员提供机会。作为一个支持性的环境，普通儿科，儿科部门和医院致力于推进她的研究事业。

DESCRIPTION (provided by applicant): This career development award supports the development of Joanne Wood, MD, MSHP as an independent researcher focusing on child maltreatment research and improving the quality of care for victims of abuse. Through the K23 award, Dr. Wood will gain advanced training in health services research and expand her skills to include qualitative research methods. Career development goals outlined in the application will serve as the basis for future investigations in the field of child maltreatment, including healthcae quality and outcomes research and quality benchmarking. Dr. Wood proposes a comprehensive research program that will serve as the foundation for future work in health services research and child maltreatment. Dr. Wood aims to develop, validate, and apply quality metrics for occult injury screening, a crucial component of the evaluation for suspected physical abuse in young children. Aim 1 will develop and validate appropriateness criteria for radiographic screening for occult injuries in young injured children. Aim 2 will construct and validate a set of algorithms for assessing the appropriateness of screening for occult injuries that can be applied to administrative data. Aim 3 will compare the quality of screening practices for occult injuries across pediatric hospitals. Aim 4 will identify factors that promote appropriat use, overuse, and underuse of screening. Her approach to address limitations in recognizing and diagnosing abuse involves the use of quantitative and qualitative methods. Dr. Wood is a junior investigator with training in health policy research and extensive experience in pediatrics and child abuse pediatrics at a large, urban children's hospital. She has assembled an outstanding multidisciplinary team of mentors led by David Rubin, MD, MSCE (primary mentor) and Chris Feudtner, MD, PhD, MPH (co-mentor) to guide her career development. Her program will include formal didactics and practical experience gained through conduct of original research using both quantitative and qualitative methods. Dr. Wood will enhance the quality of her work and future contributions to the field through the mentoring, advanced training, and supervised research experience set forth in her K23 proposal. The Children's Hospital of Philadelphia and University of Pennsylvania offer outstanding resources and mentorship that will enable Dr. Wood to develop her long-term goals. Her affiliations and familiarity with the many departments and institutes will provide access to researchers across the health system and across the University. Serving as a supportive environment, the Division of General Pediatrics, the Department of Pediatrics, and the Hospital are committed to advance her research career. PUBLIC HEALTH RELEVANCE: Occult injury screening in young children who present with injuries has been recognized as an important set of tests that can aid clinicians in diagnosing abusive injuries, which is critical to the safety and wellbeing of these children. Disparities and variation in the utilization of occult injury screening at pediatric hospitals, however, exist due o lack of clear criteria regarding the appropriate use of occult injury screening. This proposal aims to establish and evaluate criteria for appropriate use of occult injury screening, to develop and evaluate quality metrics for assessing occult injury screening practices in hospitals, and to use those metrics to assess hospital performance.