Improving Pediatric Developmental Screening and Communication: A CME

描述（由申请人提供）：发育迟缓在幼儿期很常见，影响至少10%的儿童。虽然发育迟缓并不总是表明潜在的疾病，但发育迟缓是更严重的发育疾病的标志，包括自闭症，智力残疾，言语和语言障碍。大脑在生命的头三年具有巨大的适应性，这意味着早期治疗 延迟导致结果改善，而后期干预效果较差。1 -3为了提供治疗以改善儿童的结果，儿科初级保健提供者在儿童生命的前三年内早期识别延迟和感觉障碍， 很危险有一个巨大的需求和兴趣，在早期识别儿童的发展问题的风险，与广泛关注这一主题的主要组织儿科健康。美国儿科学会于2006年5发布了关于医疗之家发育监测和筛查的最新建议，于2007年6发布了关于自闭症筛查的最新建议; NICHD强调需要对有智力迟钝风险的婴幼儿进行早期识别和干预; AHRQ发布了一个关于诊断错误研究的特别强调通知（包括诊断延迟）。7在最近的AHRQ建议声明中指出的两个关键差距8包括需要在不同人群中进行筛查策略，并将有效的、基于证据的筛查方法用于初级保健实践。筛查工具可用于一般发育筛查，但在实践中使用的特定筛查方面没有共识。虽然筛查越来越多地被儿科医生采用，但他们往往不愿意与父母讨论结果。该计划解决了对教育材料的需求，这些材料：汇集信息，以帮助儿科初级保健提供者 从2006年《澳大利亚行动计划》提供的工具中选择工具5;提供关于在实践中实施筛查的指导;并协助他们在实践中有效地宣传这些筛查的目的和结果。该计划的主要目标直接解决了在实践中实施发育筛查所涉及的一些困难。该资源将告知提供者进行发育筛查的重要性和挑战;协助提供者理解并向父母传达这些结果，并确定和承认筛查策略和结果交付中的文化考虑因素。具体目标是：具体目标1：为CME/CE项目开发完整的临床内容，重点关注初级保健和结果交流中开发筛查工具的使用、益处和局限性。具体目标二：完成基于网络的CME/CE计划的基础上，临床内容大纲和研究结果从第一阶段补助金，包括文化和社会经济多样化的儿科人群。具体目标3：与儿科初级保健提供者一起对该计划进行严格的评估。

DESCRIPTION (provided by applicant): Developmental delays are common in early childhood, affecting at least 10 percent of children. While a delay does not always indicate an underlying condition, developmental delays are markers for more severe developmental conditions including autism, intellectual disability, and speech and language disorders. The tremendous adaptability of the brain in the first three years of life means that early treatment of delays leads to improved outcomes, whereas later intervention is less effective.1-3 In order to provide treatment to improve children's outcomes, early identification of delays and sensory impairments by pediatric primary care providers during their first three years of a child's life is critical. There is a tremendous need for and interest in early identification of children at risk fr development problems, with vast attention to this topic by leading organizations for pediatric health. The American Academy of Pediatrics (AAP) released updated recommendations on Developmental Surveillance and Screening in the Medical Home in 20065 and Autism Screening in 20076; the NICHD emphasize the need for Early Identification and Interventions for Infants and Young Children at Risk for Mental Retardation; and AHRQ has issued a Special Emphasis Notice for research on diagnostic errors (including delay in diagnosis) in the ambulatory care setting.7 Two key gaps noted in a recent AHRQ recommendation statement8 included the needed for screening strategies in diverse populations, and translating effective, evidence-based screening approaches for use in primary care practices. Screening tools are available for general developmental screening, but with no consensus on the specific screens to use in practice. While screening is being increasingly adopted by pediatricians, they often remain uncomfortable discussing the results with parents. This program addresses the need for educational materials that: ¿ bring together information to assist pediatric primary care providers in choosing tools from among those provided in the 2006 AAP recommendations5; ¿ provide guidance on implementation of screening in practice; and ¿ assist them to effectively communicate the purpose and results of these screens in practice. The key goals of this program directly address some of the difficulties involved in implementing developmental screening in practice. This resource will inform providers about the importance and challenges of conducting developmental screening; assist providers in understanding and communicating those results to parents, and identifying and acknowledging cultural considerations in screening strategies and delivery of results. The specific aims are: Specific Aim 1: To develop the full clinical content for a CME/CE program that will focus on implementation of the use, benefits, and limitations of development screening tools in primary care and communication of results. Specific Aim 2: Complete the web based CME/CE program based on the clinical content outline and findings from the Phase I grant, including culturally and socioeconomically diverse pediatric populations. Specific Aim 3: Conduct a rigorous evaluation of the program with pediatric primary care providers.