Implementation of emergency department screening to impact rising syphilis rates in vulnerable populations

项目总结 自2001年以来，美国的梅毒发病率一直在稳步上升，报告的新病例超过13万例 2019年。如果不治疗，梅毒可能会导致神经、精神、心血管和其他严重的疾病 受感染母亲的婴儿除了死产或毁灭性的先天缺陷外，还会造成严重后果。梅毒 不成比例地影响少数群体，特别是黑人和西班牙裔社区。先天发病率 梅毒的发病率也在迅速上升，同时年轻女性的梅毒发病率也在上升。梅毒的检测 有生育潜力的女性将是消除先天性梅毒的关键。目前的筛查策略依赖于 对接受门诊护理的患者的症状或危险因素进行识别，但这可能导致许多 漏诊，因为梅毒可能会持续数年没有症状，患者可能不会认为自己在 风险或报告相关的风险因素，最容易感染梅毒的患者也可能是最不可能 参加常规的门诊护理。为了解决这个问题，我创建并试行了一种针对普遍梅毒的方法 在急诊科(ED)进行筛查，许多脆弱的患者优先寻求医疗护理。 我的长期目标是扩大这个计划，并创建一个强大的模型，最终可以横向扩展到 芝加哥和全国各地的其他城市急救人员，要做到这一点，我需要更多的数据和培训 在实施科学方面。在这份职业发展提案中，我将评估和改进我的筛选模型 并准备使用实施科学战略扩展到更多站点，由 探索、准备、实施、可持续(EPIS)模型，一个强大的决定因素框架 实施科学。探索阶段将包括对KEY的准备情况进行评估 我们机构以外的利益相关者采用类似的筛选模式。将开发准备阶段 同时包括对促成《联合国宪章》成败的背景因素的评价 现有的筛查计划，具体包括与此类计划相关的费用。这个 随着模型的改进和持续，实施阶段和持续阶段代表着未来的方向 随着时间的推移，在我们医院，并最终在其他机构实施，作为未来R01水平研究的一部分。这个 这项提议产生的知识将填补在如何实施成功的、有背景的-- 与护理计划有效联系的特定ED筛查计划，这可能不仅有助于增加梅毒 诊断和治疗，但也可用于筛查影响最脆弱人群的其他疾病 人口。这项K23奖项将提供实施科学、混合方法研究、 和医疗保健经济学，这将建立在我在公共卫生和流行病学方面的背景。我会带上我的 研究和临床经验，以及经验丰富的指导团队，以发展技能 成为一名独立的调查者，并最终成为ED筛查方法和 实施科学。

PROJECT SUMMARY Syphilis rates in the U.S. have been increasing steadily since 2001, with more than 130,000 new cases reported in 2019. Left untreated, syphilis can lead to neurologic, psychiatric, cardiovascular, and other severe medical consequences, in addition to stillbirth or devastating congenital defects in infants of infected mothers. Syphilis disproportionately affects minority populations, in particular Black and Hispanic communities. Rates of congenital syphilis are also rising rapidly, paralleling an increase in rates among young women. Detection of syphilis among women of childbearing potential will be key to eliminating congenital syphilis. Current screening strategies rely on identification of symptoms or risk factors in patients attending ambulatory care, but this may result in many missed diagnoses, as syphilis can remain asymptomatic for years, patients may not perceive themselves as at risk or report relevant risk factors, and the patients most vulnerable to syphilis may also be the least likely to attend routine outpatient care. To address this issue, I created and pilot-tested an approach for universal syphilis screening in the emergency department (ED), where many vulnerable patients preferentially seek medical care. My long-term goal is to scale up this program and create a robust model that can eventually be scaled-out to other urban EDs in Chicago and across the country, and to accomplish this I will need additional data and training in implementation science. In this career development proposal, I will evaluate and improve my screening model and prepare for expansion to additional sites using implementation science strategies, informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) model, a robust determinants framework in implementation science. The Exploration phase will consist of an assessment of the readiness of key stakeholders outside our institution to adopt a similar screening model. The Preparation phase will be developed concurrently to include an evaluation of the contextual factors that have contributed to successes and failures of the existing screening program, including specifically the costs associated with such programs. The Implementation and Sustainment phases represent future directions as the model is improved and sustained over time at our hospital and ultimately implemented at other institutions as part of future R01-level studies. The knowledge developed as a result of this proposal will fill important gaps in how to implement successful, context- specific ED screening programs with effective linkage to care plans, which may serve not only to increase syphilis diagnosis and treatment, but also could be applied to screening for other diseases affecting the most vulnerable populations. This K23 award will provide advanced training in implementation science, mixed methods research, and healthcare economics that will build on my background in public health and epidemiology. I will bring my research and clinical experience together with that of an experienced mentorship team to develop the skills necessary to become an independent investigator and eventually a leader in ED screening methodology and implementation science.