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.

项目概要自 2001 年以来，美国的梅毒发病率一直在稳步上升，报告的新病例已超过 13 万例 2019 年。如果不及时治疗，梅毒可能会导致神经、精神、心血管和其他严重的医疗问题除了死产或受感染母亲的婴儿出现毁灭性先天缺陷之外，还有其他后果。梅毒不成比例地影响少数民族人口，特别是黑人和西班牙裔社区。先天性的比率梅毒也在迅速上升，与年轻女性的发病率同步上升。梅毒检测有生育能力的妇女将是消除先天性梅毒的关键。目前的筛选策略依赖于识别参加门诊护理的患者的症状或危险因素，但这可能会导致许多漏诊，由于梅毒可能多年无症状，患者可能不会认为自己是在风险或报告相关风险因素，最容易感染梅毒的患者也可能是最不可能感染梅毒的患者参加常规门诊护理。为了解决这个问题，我创建并试验了一种针对普遍梅毒的方法在急诊科 (ED) 进行筛查，许多弱势患者优先寻求医疗护理。我的长期目标是扩大这个项目的规模并创建一个强大的模型，最终可以扩展到芝加哥和全国各地的其他城市急诊室，为了实现这一目标，我需要额外的数据和培训在实施科学中。在这个职业发展建议中，我将评估和改进我的筛选模型并准备利用实施科学战略扩展到更多地点，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。探索阶段将包括评估关键的准备情况我们机构以外的利益相关者采用类似的筛选模式。将开展准备阶段同时包括对促成成功和失败的背景因素的评估现有的筛查计划，特别包括与此类计划相关的费用。这实施和维持阶段代表了模型改进和维持的未来方向随着时间的推移，我们医院并最终在其他机构实施，作为未来 R01 级研究的一部分。这由于该提案而开发的知识将填补如何成功实施、符合具体情况的重要空白。与护理计划有效联系的具体急诊室筛查计划，这可能不仅会增加梅毒诊断和治疗，还可以应用于筛查影响最弱势群体的其他疾病人口。该 K23 奖项将提供实施科学、混合方法研究、以及医疗保健经济学，这将建立在我的公共卫生和流行病学背景之上。我会带上我的研究和临床经验以及经验丰富的指导团队的共同发展技能成为一名独立研究者并最终成为 ED 筛查方法的领导者是必要的实施科学。