Comprehensive Pediatric Hypertension Diagnosis and Management

小儿高血压综合诊断和管理

• 批准号: 9768965
• 负责人: Michael L Rinke
• 金额: $ 49.07万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768965
• 关键词: Comprehensive; Pediatric; Hypertension; Diagnosis; Management

ABSTRACT: Hypertension (HTN) and elevated blood pressure (EBP) lead to appreciable morbidity in pediatric patients, affecting them throughout life. Three to five percent of children have HTN, a rate that is steadily increasing. Almost 40% of pediatric HTN patients have left ventricular hypertrophy at diagnosis, suggesting delays in diagnosis and management initiation are affecting patients. Comprehensive, evidence-based guidelines for HTN diagnosis and management were updated in August 2017, but it is uncertain how to best implement HTN guidelines and reduce harm from failure to properly diagnose and manage HTN. Research by this investigative team with a national group of 30 primary care practices significantly reduced the recognition of elevated BP error rate, but strategies to move from recognition to diagnosis and management are unclear. Implementation research on primary and subspecialty care integration around HTN can serve as a model for other pediatric chronic conditions. Quality improvement collaboratives (QICs) often bring together either primary or subspecialty care physicians, but few integrate both primary and subspecialty care physicians to create comprehensive care improvement. It is unclear if pediatricians can effectively diagnose and manage chronic conditions like HTN with subspecialist back-up only, and it is uncertain how to effectively integrate primary and subspecialty care to reduce the harmful sequelae of pediatric HTN. This grant proposes to conduct a multisite, prospective, cluster-randomized trial, broadening and deepening our prior work on recognition of pediatric elevated BP, which will test methodologies to ensure every pediatric patient is screened, and if HTN or EBP are present, diagnosed and managed appropriately and expeditiously. This project will randomize at least 60 pediatric practices from across the country in a stepped-wedge fashion to a HTN QIC a) without subspecialist involvement, b) with subspecialist involvement and c) with pediatrician HTN diagnosis and management, and subspecialist back-up. It will also serve as a test case for whether pediatricians can diagnose and manage common chronic conditions (e.g., HTN) with a supporting subspecialist advisor. This proposal responds to AHRQ's Funding Opportunity Announcement PA-15-339, designed to develop evidence to improve safety in ambulatory care settings and focuses on children in rural and urban settings, AHRQ priority populations. This proposal, led by an experienced research team, will identify a clear implementation strategy for rigorous, evidenced-based pediatric HTN diagnosis and management, and highlight a model to increase primary and subspecialty care integration that can be reproduced across other chronic conditions.

抽象的： 高血压（HTN）和血压升高（EBP）导致儿科患者的发病率明显 一生都会影响他们。三到5％的儿童患有HTN，这一速度正在稳步上升。 几乎40％的小儿HTN患者在诊断时剩下心室肥大 诊断和管理启动正在影响患者。全面的，基于证据的指南 HTN诊断和管理在2017年8月进行了更新，但不确定如何最好地实施HTN 指南并减少因无法正确诊断和管理HTN而导致的伤害。这项调查的研究 由30个初级保健实践的全国组团队大大降低了对BP升高的认识 错误率，但是从识别到诊断和管理的策略尚不清楚。执行 HTN周围的初级和专科护理整合的研究可以作为其他儿科的模型 慢性条件。质量改进协作（QIC）通常将主要或 亚科医生，但很少有融合初级和专业的护理医生来创建 综合护理改进。目前尚不清楚儿科医生是否可以有效诊断和管理慢性 诸如HTN之类的条件仅具有专科医生的备份，并且不确定如何有效整合主要和 亚专科护理可减少小儿HTN的有害后遗症。这项赠款建议进行 多站点，前瞻性，群集随机试验，扩大和加深了我们先前的工作 识别小儿升高的BP，该方法将测试方法，以确保每个小儿患者都是 筛选，如果存在HTN或EBP，可以适当及时诊断和管理。 该项目将以阶梯向外的方式随机对全国各地至少60种小儿练习 到HTN QIC a）没有非专业人士的参与，b）与专科医生的参与，c）儿科医生 HTN的诊断和管理以及专性备份。它也将作为测试案例 儿科医生可以通过支持诊断和管理常见的慢性病（例如，HTN） 亚专业顾问。该提案回应AHRQ的资助机会公告PA-15-339， 旨在开发证据以提高门诊护理环境的安全性，并专注于农村的儿童 和城市环境，AHRQ优先人群。由经验丰富的研究团队领导的该建议将 确定明确的实施策略，用于严格，基于证据的儿科HTN诊断和 管理，并强调一个可以增加主要和亚专业护理整合的模型 在其他慢性疾病中复制。