There is a significant sexually transmitted infection (STI) epidemic among the adolescent population. Despite established principles for STI control, clinical practices related to screening and diagnosis, treatment, and prevention of STIs among adolescent females are suboptimal. It is urgent to expand our screening programs to nontraditional healthcare settings such as emergency departments (ED) to target those adolescents who would otherwise not receive preventive healthcare. The candidate's long term goal is to decrease STI rates among adolescents through an independent research career focused on improving reproductive health outcomes. The short term objective of this proposal is to design and test the feasibility of a universal STI screening program in a pediatric ED setting. The central hypothesis is that by expanding preventive care services (STI screening) to an ED setting aimed at targeting those adolescents who would otherwise not receive preventive healthcare, we will have an impact on the STI epidemic and overall public health. The rationale for the proposed research is that ED screening strategies will improve diagnosis of asymptomatic STIs and decrease the time interval to treatment, consequently decreasing reinfection rates, community transmission and the overall community STI burden while decreasing healthcare costs. This research will allow the candidate to establish herself as one of few investigators in the area of STIs and outcomes research among pediatric emergency medicine physicians nationally. The research proposal will fill gaps in the literature needed to design an ED STI screening program. Qualitative data will be collected to determine key factors contributing to parent/guardian and adolescent acceptability of a confidential, universal STI screening program in the ED and assess their beliefs about the feasibility of this program. Using improvement science methods, this information along with previously obtained data will be used to design and test the feasibility of a pediatric ED STI screening program. This research is novel in that it shifts the usual clinical practice paradigm in the ED from STI diagnosis in symptomatic adolescents to STI screening and prevention. This research proposal and career development plan will enhance the candidate's skills in 1) improvement science, focusing on implementation and dissemination methods; 2) qualitative research design, execution and analysis; and 3) advanced training in clinical and translational research through a Master's degree. This training will be a critical step in advancing the candidate in her research program and reaching her goal of becoming an independent outcomes researcher in the field of pediatric emergency medicine.
Sexually transmitted infections (STIs) are a significant public health problem that is most prevalent among the adolescent population. Expanding preventive care services (STI screening programs) into ED settings and using health system redesign interventions to implement screening among adolescents in the ED is an innovative approach to ensure that high risk patients are screened and effectively treated leading to a decrease in the overall rate of infected adolescents. These ED screening strategies will improve diagnosis of asymptomatic STIs and decrease the time interval to treatment, consequently decreasing reinfection rates, community transmission and the overall community STI burden while decreasing healthcare costs and improving overall public health.
