Quantitative pediatric vision screening in primary care settings in Alabama.
Quantitative pediatric vision screening in primary care settings in Alabama.
复制标题
阿拉巴马州初级保健机构中的定量儿科视力筛查。
DOI：
10.1097/opx.0b013e318185282a
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Kristofco,RobertE
中科院分区：
文献类型：
--
作者：
Marsh-Tootle,WendyL;Wall,TerryC;Tootle,JohnS;Person,SharinaD;Kristofco,RobertE
目的：亚拉巴马州医疗补助计划分别报销“客观”视力筛查（VS），即通过敏锐度或类似的定量方法，以及儿童健康检查（WCC）。我们分析了每一个service.Methods的频率。2002年10月1日和2003年9月30日之间提供的3至18岁的儿童的WCC和VS的索赔，并为所有参加儿童的汇总数据，从亚拉巴马医疗补助。我们采用单变量分析，然后进行Logistic回归，探讨潜在的影响因素（患者年龄，供应商类型，供应商的WCCs的体积）上接收VS在学龄前age.Results.Children接受WCCs是55%的黑色，40%白色，和5%的其他。WCC索赔的儿童死亡率在4岁时最高（57%），此后在6至14岁时下降到30%，在18岁时下降到< 10%。几乎所有的VS（每个年龄> 98%）都发生在WCC的同一天。儿科医生提供了68%的WCC。多变量分析，在调整了学龄前患者在提供者中的嵌套后，显示VS的比值比（OR）随患者年龄的增加而增加（5年vs. 3年，OR= 3.57，p< 0.0001），非医生提供者类型（非医生vs.儿科医生，OR= 1.80，p= 0.0004）和高WCC体积（等于或高于与低于每个提供者每年WCC的中位数（n= 8）（OR= 7.11，p< 0.0001））。因为当参加WCC访问的人数很少时，VS率很高，所以很少有登记的儿童在任何年龄接受VS（3岁时为6%，4岁时为13%，结论：由于儿童无法接受筛查，而且由于提供者错过了许多在学龄前筛查视力的机会，因此国家在减少可预防的弱视视力丧失方面的努力受到了阻碍。学龄。改善VS的努力应该针对儿科医生主导的实践，因为这些服务于更多的儿童。
Purpose.Alabama Medicaid reimburses “objective” vision screening (VS), ie, by acuity or similar quantitative method, and well child checks (WCCs) separately. We analyzed the frequency of each service obtained.Methods.Claims for WCC and VS provided between October 1, 2002 and September 30, 2003 for children aged 3 to 18 years, and summary data for all enrolled children, were obtained from Alabama Medicaid. We used univariate analysis followed by logistic regression to explore the potential influence of factors (patient age, provider type, and provider’s volume of WCCs) on the receipt of VS at pre-school ages.Results.Children receiving WCCs were 55% black, 40% white, and 5% other. Percentages of children with WCC claims were highest at 4 years (57%) and thereafter declined to 30% at 6 to 14 years and to< 10% at 18 years. Nearly all VS (> 98% at each age) occurred the same day as the WCC. Pediatricians provided 68% of all WCCs. Multivariate analysis, after adjusting for nesting of pre-school patients within provider, showed the odds ratios (ORs) of VS were increased by patient age (5 years vs. 3 years, OR= 3.57, p< 0.0001), nonphysician provider type (nonphysician vs. pediatrician, OR= 1.80, p= 0.0004) and high WCC volume (at or above vs. below the median number (n= 8) of WCC per provider per year (OR= 7.11, p< 0.0001)). Because VS rates were high when attendance to WCC visits was low, few enrolled children received VS at any age (6% at the age of 3, 13% at the age of 4, and a maximum of 20% at the age of 5).Conclusions.National efforts to reduce preventable vision loss from amblyopia are hampered because children are not available for screening and because providers miss many opportunities to screen vision at pre-school age. Efforts to improve VS should target pediatrician-led practices, because these serve greater numbers of children.