This career development award supports the development of Daniel Lindberg MD into an independent investigator focused on the early recognition of child physical abuse. Through this K23 award, Dr. Lindberg will gain mentored experience to develop tools based in the electronic health record that help doctors improve their testing decisions for children with concern for physical abuse. These tools will improve adherence with best- practice guidelines; in so doing, they will improve abuse recognition, reduce the costs and risks of avoidable testing, and decrease variability according to race and economic factors. The career development goals of this proposal are to allow Dr. Lindberg to develop skills in informatics and dissemination & implementation science. These skills will provide the foundation for an independent research career that will translate the best evidence within the field to the large community of physicians who care for abused children. The mentored activities proposed in this application will follow 3 core aims. First, Dr. Lindberg will use surveys and focus groups to identify those guidelines that are perceived by doctors to have the highest priority for quality improvement. In this aim, he will determine the workflow patterns where decision support tools are most likely to improve testing decisions. Next, he will design the clinical decision support tools and ensure that they are able to be used in 3, separate clinica environments. Finally, he will test the ability of these tools to improve guideline adherence by physicians, and further to improve abuse recognition and decrease practice variation. Dr. Lindberg is a junior investigator - an emergency physician and child abuse specialist whose research experience to date has dealt with observational studies of abuse testing by child abuse physicians. These prior studies have contributed to the understanding of best practices for abuse testing, but the lack of robust dissemination and implementation work has limited their effect on the broader field. Dr. Lindberg has assembled a strong team of mentors to supervise the core areas of the proposed research. The primary mentor is Dr. Desmond Runyan, who will supervise the child abuse and interventional research aspects of Dr. Lindberg's career development. As the National Program Director for the Robert Wood Johnson Foundation's Clinical Scholars Program, and the Principal Investigator of the LONGSCAN network, Dr. Runyan is one of the nation's premier child abuse researchers and an experienced mentor of junior investigators. Dr. Russell Glasgow will serve as co-mentor with primary responsibility for guiding the dissemination and implementation portions of the proposal. As the primary developer of the RE-AIM framework for dissemination and implementation, Dr. Glasgow has a strong record of funded research and has successfully mentored several junior investigators. Finally, Dr. Lalit Bajaj will serve as co-mentor, with primary responsibility for guiding the informatics portions of the proposal. As the medical director of the Children's Hospital Colorado Clinical Research Organization and an active contributor to the PECARN network for pediatric emergency medicine, Dr. Bajaj is a leader in the field of clinical informatics, and the ideal mento to ensure successful completion of the informatics portion of this proposal. Within the University of Colorado School of Medicine, Dr. Lindberg will have access to graduate courses, seminars and most importantly, mentored experience to complete the proposed research. As one of the nation's leading centers for federally funded research, Dr. Lindberg will have access to all necessary tools to complete research and career development activities. In addition to a robust infrastructure for clinical informatics, the University boasts the Kempe Center for the prevention and treatment of Child Abuse and Neglect, one of the nation's leading, comprehensive centers for the care of abused children.

Public Health Relevance

Despite a growing body of evidence defining best practices for the use of testing to recognize abused children, physical abuse continues to be commonly missed by doctors, exposing children to increased risk and escalating abuse. This proposal will provide mentored research training to develop tools based in the electronic health record that will remind doctors of the best practices to improve abuse recognition, and to decrease the use of avoidable testing. It will have direct impact on public health by improving the recognition and protection of abused children, and decreasing the variability of abuse testing

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Biobehavioral and Behavioral Sciences Subcommittee (CHHD)
Program Officer
Maholmes, Valerie
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University of Colorado Denver
Emergency Medicine
Schools of Medicine
United States
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Tiyyagura, Gunjan; Christian, Cindy; Berger, Rachel et al. (2018) Occult abusive injuries in children brought for care after intimate partner violence: An exploratory study. Child Abuse Negl 79:136-143
Henry, M Katherine; French, Benjamin; Feudtner, Chris et al. (2018) Cervical Spine Imaging and Injuries in Young Children With Non-Motor Vehicle Crash-Associated Traumatic Brain Injury. Pediatr Emerg Care :
Lindberg, Daniel M (2018) Bias and Objectivity When Evaluating Social Risk Factors for Physical Abuse: of Babies and Bathwater. J Pediatr 198:13-15
Lindberg, Daniel M; Scribano, Philip V (2017) A child abuse research network: Now what? Child Abuse Negl 70:406-407
Lindberg, Daniel M; Wood, Joanne N; Campbell, Kristine A et al. (2017) Research priorities for a multi-center child abuse pediatrics network - CAPNET. Child Abuse Negl 65:152-157
Lindberg, Daniel M; Runyan, Desmond K (2016) Improving Clinical Judgment in Abuse Case Finding. Pediatrics 138: