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Information about ongoing health services research and public health projects
| Systems approach to universal teen Chlamydial screening
(Archived Project) |
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|---|---|
| Investigator (PI): | Shafer, Mary Ann |
| Performing Organization (PO): |
(Current): University of California, San Francisco, School of Medicine, Department of Pediatrics |
| Supporting Agency (SA): | Agency for Healthcare Research and Quality (AHRQ) || National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) |
| Initial Year: | 1999 |
| Final Year: | 2006 |
| Record Source/Award ID: | CRISP/R01HS010537 |
| Funding: | Total Award Amount: $2,687,506 1999 Award Amount: $520,154 2000 Award Amount: $497,044 2001 Award Amount: $462,222 2003 Award Amount: $438,600 2004 Award Amount: $453,965 2005 Award Amount: $315,521 |
| Award Type: | Grant |
| Award Information: | Reports resulting from this project |
| Abstract: | Background: C. trachomatis (CT) remains epidemic among sexually active adolescent females. Yet the goal of universal screening in the office setting has remained elusive even with the recent introduction of the non-invasive accurate urine based tests that eliminate the necessity of pelvic exams to obtain CT specimens. The long term goal of this TRIP I continuation proposal is to develop a Clinical Practice Intervention (CPI) that will increase CT screening of adolescent females at the point of care regardless of the reason for the visit. We have shown success with this CPI process applied to CT screening during health maintenance visits (HMV) which resulted in an increase from 5% screening at baseline to 65% post-CPI. During the course of our initial TRIP I work, we demonstrated that 2/3 of the target teens attended only same day/urgent care visits (UCVs) and were missed by the HMV focused CT screening. We propose to extend our work to meet the needs of these adolescents by providing CT screening in the urgent care setting. Aim: To significantly increase CT screening in sexually active adolescent females in the urgent care setting through the implementation of a new Clinical Practice Improvement intervention (CPI) that will facilitate the redesign of clinic systems to meet the unique demands of the adolescent and of the urgent care setting. HMO Setting and Population: Ten pediatric urgent care clinics will be selected from a large regional HMO of 34 clinics serving 97,000 females aged 14-18 years. Design/Methods: We will evaluate the effectiveness of the CPI-Urgent Care Intervention by randomizing 10 clinics to either the intervention or control group. The CPI-Urgent Care will consist of 1) engaging the leadership and staff; 2) building teams within clinic staff to accomplish the task; 3) re-designing clinical practice using rapid cycle quality improvement and "Plan-Do-Study-Act" cycles; 4) sustaining the gains through the continuous monitoring the performance; and 5) developing new tools to improve the efficiency of CT screening in urgent care. This study includes a process evaluation component to evaluate how improvements are achieved and sustained over time. Analysis: Analysis will assess whether the changes in the proportions of sexually active adolescent females screened from baseline to post-intervention differ between the intervention and control clinics. |
| Abstract Archived: |
Sexually transmitted diseases (STDs) remain epidemic among sexually active adolescents. Addressing the problem within a primary care setting has been hindered by a number of barriers including the lack of screening for sexual activity and STD risk by the physician and by the lack of an accurate non-invasive screening test for C. trachomatis (CT) and N.gonorrhoeae (GC) and. Recently the nucleic acid amplification tests (NAATs) for CT and GC have been successfully applied to first void urines thereby obviating the need for traditional invasive screening (pelvic exam in females, urethral swab in males), yet the adoption of this technique for screening has been slow. To determine whether a "systems-level" intervention based on the Precede-Proceed model and targeting and training designated intake clinic nurses (intervention) results in an increased rate of urine-based screening for CT and GC in asymptomatic sexually active adolescents attending general HMO pediatric practice clinics compared to the traditional physician initiated screening model (control). Pediatric clinics caring for teens in a large regional HMO will be the target. In this quasi-experimental design, 10 clinics (500 teens in each clinic) will be grouped into the 2 conditions: 5 into the intervention and 5 into the control. Intervention: A designated nurse/medical assistant (nurse/MA) in each clinic will receive 4 hours of training to properly ask teens about sexual activity and subsequently to obtain urines for STD screening among the sexually active. The nurse/MA will have ongoing supervision and support. Physicians in the same condition will receive 1.5 hour workshop on the importance of urine screening using the new NAATs in the sexually active teen to increase support of the nurse/MA role. Control: These clinics will remain in the traditional "physician initiated" STD screening model. Physicians will receive a 1 hour didactic lecture on STDs in teens and the technology of the new NAATs for screening for CT and GC. No other staff will be included. NAATs for CT and GC will be available to all clinics. Data sources will include number and percent of sexually active teens screened with urines in each clinic, and demographic data obtained from a central patient information computer data bank. Analysis will focus on a comparison of urine screening among sexually active teens in the control and intervention clinics adjusting for potential teen and clinic differences. |
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| Country: | United States |
| State: | California |
| Zip Code: | 94122 |
| UI: | 20043201 |
| Project Status: | Archived |
| Record History: | ('2005: NICHD provided funding; Project extended to 2007. 2003: Project title changed (Prior title: Do urine tests increase chlamydia screening in teens); Abstract archived and replaced; Project extended to 2006.',) |
