An eHealth solution for posttraumatic stress and pain screening integrated in pediatric injury care

摘要 儿科伤害是美国儿童死亡和后天残疾的主要原因，影响到20 每年有一百万儿童。仅学龄儿童中就有200多万人在紧急情况下接受治疗 每年因受伤而住院或住院，产生数十亿美元的医疗和工作损失费用 每年。出院后，许多受伤的儿童经历了无法很好控制的疼痛， 大约每6人中就有1人出现持续性创伤后应激症状(PTSS)。Pain和PTSS都有 已被证明与受伤后的健康和功能结果有关。 卫生系统面临着越来越多的对短期和长期患者结果的经济责任，但很少有 有能力定期筛查受伤儿童康复不良的可修改因素的指标 患者从医院或急诊科出院后，阻碍后续护理并损害 最佳结果。目前还没有实用、有效的手段来筛查儿童出院后的疼痛， 及时进行PTSS和功能恢复，并使这些数据对医疗保健系统可操作 利益攸关方或受益人，如父母。 我们提出了一种新的、有效的儿童自我报告筛查系统，用于儿童创伤患者 以儿童友好的方式，实时评分，并与外部医疗保健IT系统集成。系统 解决未得到满足的紧急需求，并将通过将筛查结果与 后续护理和预测性分析，以改善受伤结果。建立在第一阶段工作的基础上， 论证了系统的可行性、可用性、主观感染力和商业潜力，并借鉴了 主要利益相关者，该二期项目继续进行系统开发和商业化，并积极 潜在客户的参与。集成的数字筛选系统充分利用了 电子健康和适合发展的用户参与战略，以及经济转型 为卫生系统提供激励措施，以优化患者的短期和长期结果 并实现对卫生信息技术的有意义的使用。拟议的技术转让和 商业化努力得到了长达十年的强大行业/学术技术转移的支持 非常适合儿科创伤护理转型的合作伙伴关系。

ABSTRACT Pediatric injury is the leading cause of child mortality and acquired disability in the United States, affecting 20 million children annually. Among school age children alone, more than 2 million are treated in Emergency Department or admitted to the hospital annually for injury, incurring billions in medical and work-loss costs each year. After hospital discharge, many injured children experience pain that is not well-controlled, and approximately 1 in 6 develops persistent posttraumatic stress symptoms (PTSS). Both pain and PTSS have been shown to be associated with health and functional outcomes following injury. Health systems face increasing economic accountability for short- and long-term patient outcomes, but few have the ability to routinely screen for indicators of modifiable factors for poor recovery in injured pediatric patients after discharge from the hospital or emergency department, hampering follow-up care and impairing optimal outcomes. There is currently no practical, validated means to screen children, post-discharge, for pain, PTSS and functional recovery in a timely fashion and to make these data actionable to healthcare system stakeholders or to beneficiaries such as parents. We propose a novel, validated child self-report screening system that is delivered to pediatric trauma patients in a child-friendly modality, scored in real time, and integrated with external healthcare IT systems. The system addresses an urgent unmet need, and will transform pediatric trauma care by connecting screening results to follow-up care and predictive analytics to improve injury outcomes. Building on Phase I efforts that demonstrated the system’s feasibility, usability, subjective appeal and commercial potential, and learned from key stakeholders, this Phase II project continues system development and commercialization, with the active involvement of a potential customer. The integrated digital screening system takes advantage of advances in e-Health and developmentally-appropriate user engagement strategies, as well as a shifting economic landscape that provides health systems with incentives for optimizing short- and long-term patient outcomes and achieving meaningful use of health information technology. The proposed technology-transfer and commercialization effort is supported by a decade-long strong industry/academic technology transfer partnership that is ideally suited for pediatric trauma care transformation.