Decreasing teen STI prevalence through universal emergency department screening

描述(申请人提供)：青少年人群中有严重的性传播感染(STI)流行。尽管已经确立了性传播感染控制的原则，但与青春期女性性传播感染的筛查和诊断、治疗和预防相关的临床实践并不理想。当务之急是将我们的筛查计划扩展到非传统医疗保健环境，如急诊科(ED)，以瞄准那些本来不会接受预防性医疗保健的青少年。候选人的长期目标是通过专注于改善生殖健康结果的独立研究生涯来降低青少年的性传播感染比率。这项建议的短期目标是设计和测试在儿科ED环境中普遍的性传播感染筛查计划的可行性。中心假设是，通过将预防保健服务(性传播感染筛查)扩大到ED环境，旨在针对那些本来不会获得预防性保健的青少年，我们将对待性传播感染流行和整体公共卫生产生影响。拟议研究的基本原理是，ED筛查策略将改善对无症状性传播感染的诊断，缩短治疗间隔时间，从而降低再感染率、社区传播和整体社区性传播感染负担，同时降低医疗成本。这项研究将使候选人成为全国儿科急诊医生中性传播感染和结果研究领域为数不多的研究人员之一。该研究提案将填补设计ED STI筛查计划所需的文献空白。将收集定性数据，以确定有助于父母/监护人和青少年在ED接受保密的、普遍的性传播感染筛查计划的关键因素，并评估他们对该计划可行性的信念。利用改进的科学方法，这些信息将与先前获得的数据一起用于设计和测试儿科ED STI筛查计划的可行性。这项研究是新颖的，因为它将ED通常的临床实践范式从对有症状的青少年的STI诊断转变为STI的筛查和预防。这项研究提案和职业发展计划将增强候选人在1)改进科学方面的技能，重点是实施和传播方法；2)定性研究设计、执行和分析；以及3)通过硕士学位在临床和翻译研究方面的高级培训。这次培训将是推进候选人在她的研究计划中的关键一步，并实现她成为儿科急救医学领域的独立成果研究员的目标。

DESCRIPTION (provided by applicant): There is a significant sexually transmitted infection (STI) epidemic among the adolescent population. Despite established principles for STI control, clinical practices related to screening and diagnosis, treatment, and prevention of STIs among adolescent females are suboptimal. It is urgent to expand our screening programs to nontraditional healthcare settings such as emergency departments (ED) to target those adolescents who would otherwise not receive preventive healthcare. The candidate's long term goal is to decrease STI rates among adolescents through an independent research career focused on improving reproductive health outcomes. The short term objective of this proposal is to design and test the feasibility of a universal STI screening program in a pediatric ED setting. The central hypothesis is that by expanding preventive care services (STI screening) to an ED setting aimed at targeting those adolescents who would otherwise not receive preventive healthcare, we will have an impact on the STI epidemic and overall public health. The rationale for the proposed research is that ED screening strategies will improve diagnosis of asymptomatic STIs and decrease the time interval to treatment, consequently decreasing reinfection rates, community transmission and the overall community STI burden while decreasing healthcare costs. This research will allow the candidate to establish herself as one of few investigators in the area of STIs and outcomes research among pediatric emergency medicine physicians nationally. The research proposal will fill gaps in the literature needed to design an ED STI screening program. Qualitative data will be collected to determine key factors contributing to parent/guardian and adolescent acceptability of a confidential, universal STI screening program in the ED and assess their beliefs about the feasibility of this program. Using improvement science methods, this information along with previously obtained data will be used to design and test the feasibility of a pediatric ED STI screening program. This research is novel in that it shifts the usual clinical practice paradigm in the ED from STI diagnosis in symptomatic adolescents to STI screening and prevention. This research proposal and career development plan will enhance the candidate's skills in 1) improvement science, focusing on implementation and dissemination methods; 2) qualitative research design, execution and analysis; and 3) advanced training in clinical and translational research through a Master's degree. This training will be a critical step in advancing the candidate in her research program and reaching her goal of becoming an independent outcomes researcher in the field of pediatric emergency medicine.