Adherence to Clinical Practice Guidelines for Screening and Management of Pediatric High Blood Pressure within a Massachusetts Safety-Net Health Care System

遵守马萨诸塞州安全网医疗保健系统内儿童高血压筛查和管理的临床实践指南

• 批准号: 10464844
• 负责人: Melissa Goulding
• 金额: $ 3.4万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10464844
• 关键词: Academy; Address; Adherence; Adolescent; Adult; Affect; American; Area; Atherosclerosis; Attention; Automobile Driving; Awareness; Biological; Black race; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Cerebrovascular Disorders; Child; Childhood; Chronic Disease; Clinic; Clinical; Clinical Data; Clinical Practice Guideline; Cohort Studies; Data; Detection; Diagnosis; Dietary Practices; Disease; Dyslipidemias; Early identification; Electronic Health Record; Ensure; Environment; Ethnic Origin; Ethnic group; Family history of; Frequencies; Functional disorder; Future; Goals; Guideline Adherence; Guidelines; Health; Healthcare; Healthcare Systems; Heart Diseases; Heterogeneity; High Prevalence; Hypertension; Incidence; Interview; Investigation; Knowledge; Latino; Lead; Learning; Left Ventricular Mass; Life; Life Cycle Stages; Link; Low Birth Weight Infant; Low Prevalence; Massachusetts; Metabolic syndrome; Methods; National Heart, Lung, and Blood Institute; Not Hispanic or Latino; Obesity; Overweight; Patients; Pediatrics; Perception; Physical activity; Play; Population; Populations at Risk; Positioning Attribute; Prevalence; Prevalence Study; Preventive care; Primary Health Care; Primary Prevention; Process; Provider; Publications; Race; Reporting; Research Personnel; Risk; Risk Factors; Risk Management; Sleep Disorders; Strategic vision; System; Training; Universities; Update; Visit; Weight Gain; Work; Youth; aged; cardiovascular disorder risk; cardiovascular health; comparison group; early childhood; ethnic health disparity; experience; follow-up; health difference; health disparity; hypertension control; improved; low socioeconomic status; male; medical schools; population based; prevent; racial and ethnic; racial disparity; safety net; screening; screening guidelines; social; social health determinants; uptake

PROJECT SUMMARY Cardiovascular trajectories begin in early childhood and continue across the life course. Early recognition and management of cardiovascular disease (CVD) risk factors in childhood stand to improve these trajectories and prevent CVD risk factors in adulthood. One CVD risk factor which in conjunction with obesity has gained prominence in childhood and which affects about 1 in every 25 children in the U.S is hypertension. Health disparities which are intrinsically linked to social determinants of health (i.e., the circumstances that children live in), persist in the prevalence of hypertension with consistently higher rates of this condition seen in those of lower socioeconomic status and those of Black race and Latino ethnicity. The American Academy of Pediatrics (AAP) 2017 Clinical Practice Guidelines recommend regular screening and follow-up for the detection and management of hypertension. However, diagnosis of this condition is rare (~74% undiagnosed), and there are racial disparities in the likelihood of diagnosis as white children are more likely to have this condition diagnosed. Understanding the processes that lead to a diagnosis of hypertension (e.g., blood pressure screening and follow-up), since the release of the updated AAP guidelines, is lacking. Therefore, the goal of the present investigation is to describe the current state of pediatric blood pressure screening and follow-up according to the 2017 AAP guidelines. Using retrospective electronic health record data for children aged 3-17 years from the UMass Memorial Health Care System, a safety-net system, and the largest non-for profit health care system in Central Massachusetts, we will: (1) conduct a one year period prevalence study to quantify the prevalence of guideline adherent blood pressure screening and examine disparities in lack of receipt of guideline concordant care; (2) conduct a cohort study through which we will describe the cumulative incidence of guideline adherent follow-up after the detection of high blood pressure and disparities in the lack of receipt of guideline concordant care; and (3) conduct a qualitative study through which we will describe providers’ experiences with and perceptions of clinical practice guidelines for pediatric blood pressure screening and follow-up. Through the present work it is hypothesized that inequities in care, heterogeneity in follow-up, and challenges to guideline adherence will be identified to inform future efforts to improve clinical practice guideline uptake and pediatric preventive care. Supported by a robust academic environment at the University of Massachusetts Medical School, and a rigorous, tailored training plan, this F31 will position Ms. Goulding to become an independent investigator addressing CVD health disparities among youth.

项目概要 心血管轨迹始于儿童早期，并贯穿生命历程。 儿童时期心血管疾病（CVD）危险因素的管理可以改善这些轨迹 预防成年期心血管疾病危险因素 与肥胖相关的一种心血管疾病危险因素。 高血压是儿童时期的一个突出问题，影响着美国每 25 名儿童中约 1 名。 与健康问题社会决定因素（即儿童所处的环境）有着内在联系的差异 居住），高血压的患病率持续存在，并且这种情况在以下人群中的发病率始终较高 较低的社会经济地位以及黑人种族和拉丁裔种族。 (AAP) 2017 年临床实践指南建议定期筛查和随访，以检测和跟踪 然而，这种情况的诊断很少（约 74% 未确诊），并且存在这种情况。 诊断可能性的种族差异，因为白人儿童更有可能患有这种疾病 了解导致高血压诊断的过程（例如血压）。 自更新的 AAP 指南发布以来，缺乏筛选和后续行动的目标。 本次调查旨在描述儿童血压筛查和随访的现状 根据 2017 年 AAP 指南，使用 3-17 岁儿童的回顾性电子健康记录数据。 距麻省大学纪念医疗保健系统、安全网系统和最大的非营利性医疗保健系统数年 在马萨诸塞州中部的护理系统中，我们将：(1) 进行为期一年的患病率研究，以量化 遵循指南进行血压筛查的普及率，并检查因缺乏接受血压筛查而存在的差异 指导一致护理；（2）进行队列研究，通过该研究我们将描述累积发生率 检测出高血压后遵循指南的随访情况以及未收到高血压报告的差异 指导一致护理；以及 (3) 进行定性研究，通过该研究我们将描述提供者的情况 对儿科血压筛查临床实践指南的经验和看法 通过目前的工作，人们重新认识到护理方面的不平等、随访方面的异质性以及 将确定指南遵守方面的挑战，为未来改进临床实践指南的努力提供信息 得到了大学强大的学术环境的支持。 马萨诸塞州医学院，以及严格的、量身定制的培训计划，这架 F31 将使古尔丁女士能够 成为解决青少年心血管疾病健康差异的独立调查员。