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

实施急诊科筛查以影响弱势群体不断上升的梅毒发病率

基本信息

批准号：
10525502
负责人：
Kimberly Stanford
金额：
$ 18.6万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-25 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10525502
关键词：
Accident and Emergency department Address Adopted Adoption Adult Affect Ambulatory Care American Area Black race Cardiovascular system Caring Case Study Characteristics Chicago Clinic Clinic Visits Clinical Clinical Investigator Communicable Diseases Communities Congenital Abnormality Congenital Syphilis Cost Analysis Country Data Detection Diagnosis Disease Dissemination and Implementation Emergency department screening Epidemic Epidemiology Evaluation Evidence based practice Exploration Preparation Implementation and Sustainment Failure Feasibility Studies Female of child bearing age Financial Hardship Foundations Future Goals Healthcare Systems Hospitals Incidence Individual Infection Institution Interruption Interview Knowledge Lead Left Location Medical Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Methods Minority Groups Modeling Mothers National Institute of Allergy and Infectious Disease Neurologic Outcome Patients Persons Phase Population Heterogeneity Population Surveillance Pregnant Women Preparation Prevention Primary Health Care Primary Prevention Provider Public Health Reach Effectiveness Adoption Implementation and Maintenance Readiness Reporting Research Research Methodology Research Personnel Research Training Risk Risk Factors Services Sexually Transmitted Diseases Site Source Suggestion Symptoms Syphilis Syphilis Serodiagnosis System Testing Time Training United States National Institutes of Health Vulnerable Populations Woman Work aged base black patient burden of illness career development child bearing contextual factors cost disease transmission economic evaluation economic implication experience follow-up health care economics high risk hispanic community implementation barriers implementation outcomes implementation science implementation strategy improved infant infection infection risk innovation meetings member men who have sex with men obstetric care pilot test programs racial and ethnic disparities reproductive routine care scale up screening screening program skills stillbirth success surveillance data sustainability framework uptake young woman

项目摘要

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.

项目摘要自2001年以来，美国的梅毒率一直在稳步上升，有13万新案件报道在2019年。未经治疗，梅毒会导致神经系统，精神病，心血管和其他严重的医学后果，除了死产或毁灭性的先天性缺陷外，受感染母亲的婴儿缺陷。梅毒不成比例地影响少数民族，特别是黑人和西班牙裔社区。先天性率梅毒也正在迅速上升，与年轻女性的发生率增加。检测梅毒生育潜力的妇女将是消除先天性梅毒的关键。当前的筛选策略依赖关于鉴定参加门诊护理的患者的症状或危险因素，但这可能导致许多遗体诊断，因为梅毒会保持无症状多年，患者可能不会认为自己风险或报告相关风险因素，最容易受到梅毒的患者也可能是最不可能的参加常规门诊护理。为了解决这个问题，我创建并试点测试了通用梅毒的方法在急诊科（ED）中进行筛查，许多脆弱患者优先寻求医疗服务。我的长期目标是扩展该程序并创建一个可靠的模型，最终可以扩展到芝加哥和全国各地的其他城市ED，为此，我将需要其他数据和培训在实施科学中。在这个职业发展建议中，我将评估和改进筛查模型并准备使用实施科学策略扩展到其他站点，探索，准备，实施，维持（EPIS）模型，一个强大的决定因素框架实施科学。勘探阶段将包括对密钥准备的评估我们机构以外的利益相关者采用类似的筛选模型。准备阶段将开发同时包括对有助于成功和失败的上下文因素的评估现有的筛选计划，包括与此类计划相关的费用。这实施和维持阶段代表未来的方向，因为该模型得到了改进和持续随着时间的流逝，作为未来R01级研究的一部分，并最终在其他机构实施。这由于该提案而发展的知识将填补如何实施成功的上下文 - 特定的ED筛查计划与护理计划有效联系，这不仅可以增加梅毒诊断和治疗，但也可以用于筛查其他影响最脆弱的疾病人群。该K23奖将提供实施科学，混合方法研究的高级培训，以及将在我的公共卫生和流行病学背景下建立的医疗经济学。我会带我的研究和临床经验以及经验丰富的指导团队的研究和临床经验成为一名独立研究者，并最终成为ED筛选方法的领导者和实施科学。