Improving Pediatric Developmental Screening and Communication: A CME

描述(由申请人提供)：发育迟缓在儿童早期很常见，至少有10%的儿童受到影响。虽然发育迟缓并不总是意味着潜在的疾病，但发育迟缓是更严重的发育状况的标志，包括自闭症、智力残疾以及言语和语言障碍。大脑在生命的前三年具有巨大的适应性，这意味着早期治疗 延误导致改善结果，而后期干预效果较差。1-3为了提供改善儿童结局的治疗，儿科初级保健提供者在儿童生命的头三年及早发现延误和感觉障碍。 危急时刻。儿科健康的主要组织对这一主题给予了极大的关注，因此，对早期识别有发育问题风险的儿童有着极大的需求和兴趣。美国儿科学会发布了关于20065年医疗之家的发育监测和筛查以及20076年自闭症筛查的最新建议；美国儿科学会强调有必要对有精神发育迟滞风险的婴幼儿进行早期识别和干预；美国儿科学会发布了一份关于门诊护理环境中诊断错误(包括诊断延误)研究的特别强调通知。筛查工具可用于一般的发育性筛查，但在实践中使用的具体筛查还没有达成共识。虽然筛查越来越多地被儿科医生采用，但他们经常感到不舒服，与父母讨论结果。该方案满足了对教育材料的需求，这些材料将信息汇集在一起，以帮助儿科初级保健提供者 从2006年AAP建议5所提供的工具中选择工具；？为在实践中实施筛选提供指导；并协助他们在实践中有效地传达这些筛选的目的和结果。该方案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。这一资源将使提供者了解开展发育性筛查的重要性和挑战；协助提供者理解这些结果并将其传达给父母，并确定和承认筛查战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计划制定完整的临床内容，重点是初级保健和结果交流中开发筛查工具的使用、好处和局限性的实施。具体目标2：根据临床内容大纲和第一阶段赠款的结果，完成基于网络的CME/CE计划，包括文化和社会经济多样化的儿科人口。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.