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

摘要 在美国，儿童损伤是儿童死亡和后天残疾的主要原因，影响20 每年有100万儿童。仅在学龄儿童中，就有200多万人在急诊室接受治疗。 每年因受伤而住院或住院，造成数十亿美元的医疗和工作损失 每年.出院后，许多受伤的儿童经历的疼痛没有得到很好的控制， 大约六分之一的人会出现持续的创伤后应激症状（PTSS）。疼痛和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短期和长期患者结果的经济责任，但很少 有能力定期筛查受伤儿科患者恢复不良的可改变因素指标 病人出院后或急诊科，妨碍后续护理和损害 最佳结果。目前还没有实用的、有效的方法来筛查出院后的儿童的疼痛， 及时进行PTSS和功能恢复，并使这些数据可用于医疗保健系统 利益相关者或受益者，如父母。 我们提出了一个新的，有效的儿童自我报告筛选系统，是交付给儿科创伤患者 在一个儿童友好的模式，在真实的时间评分，并与外部医疗保健IT系统集成。系统 解决了一个迫切的未满足的需求，并将通过将筛查结果与 后续护理和预测分析，以改善损伤结果。在第一阶段努力的基础上， 展示了该系统的可行性、可用性、主观吸引力和商业潜力，并从 关键利益相关者，这个第二阶段项目继续系统开发和商业化，积极 潜在客户的参与。集成数字筛选系统利用了 电子卫生和发展适当的用户参与战略，以及不断变化的经济 为卫生系统提供激励措施，以优化短期和长期患者结局的格局 以及实现对卫生信息技术的有意义的使用。拟议的技术转让 商业化努力得到了长达十年的强大工业/学术技术转让的支持 这是一个非常适合儿科创伤护理转型的伙伴关系。

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.