A critical assessment of Transcranial Doppler screening rates in a large pediatric sickle cell center: Opportunities to improve healthcare quality
A critical assessment of Transcranial Doppler screening rates in a large pediatric sickle cell center: Opportunities to improve healthcare quality
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DOI：
10.1002/pbc.21677
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发表时间：
2008-11-01
影响因子：
3.2
通讯作者：
Mueller, Brigitta U.
中科院分区：
文献类型：
--
作者：
Raphael, Jean L.;Shetty, Priya B.;Mueller, Brigitta U.
背景资料。经颅多普勒超声(TCD)已被证明是儿童人群中由镰状细胞病(SCD)引起的中风风险的有力预测因子。关于这一医疗创新如何传播到SCD的预防护理中，人们知之甚少。这项研究的目的是确定SCD儿童的TCD筛查率和可修改的患者障碍。程序。我们在德克萨斯儿童镰刀细胞中心对207名SCD儿童进行了为期3年(2004-2006)的筛查。从计算机化的医疗记录数据库中获得人口统计数据、坚持全面护理访问的情况、疾病的严重程度以及与镰状细胞中心的距离。从计算机化的订单录入系统中提取患者取消或错过的筛查。结果。符合条件的患者的年平均筛查率为45%。患者的年均取消率为20%。私人保险的患者接受有序筛查的可能性是医疗补助患者的三倍(P=0.0077)。坚持血液学综合护理的患者比暴乱患者更有可能接受有序筛查(P=0.0386)。当每年至少有一次机会时，提供商平均会在74%的时间内要求进行TCD筛查。结论。尽管有证据表明，评估中风风险的常规筛查对SCD的预防护理至关重要，但由于患者和提供者相关因素，这项医疗保健技术的实施可能会缓慢传播。
Background. Transcranial Doppler ultrasound (TCD) has been demonstrated to be a powerful predictor of stroke risk due to sickle cell disease (SCD) in pediatric populations. Little is known about how this healthcare innovation has disseminated into preventive care for SCD. The objective of this study was to determine TCD screening rates and modifiable patient barriers in children with SCD. Procedure. We retrospectively assessed the screening of 207 children with SCD at the Texas Children's Sickle Cell Center over a 3-year period (2004-2006). Demographics, adherence to comprehensive care visits, severity of disease, and distance from the sickle cell center were obtained from computerized medical record databases. Screenings cancelled or missed by patients were extracted from a computerized order entry system. Results. The average yearly screening rate for eligible patients was 45%. The average yearly cancellation rate by patients was 20%. Patient with private insurance were three times more likely to be compliant with ordered screenings than patients with Medicaid (P = 0.0077). Patients adherent to hematology comprehensive care visits more likely Underwent ordered screenings than those who were riot (P = 0.0386). When given at least one opportunity per year, providers, on average, ordered TCD screening 74% of the time when it was indicated. Conclusions. Despite evidence that routine screening to assess stroke risk is vital to the preventive care of SCD, implementation of this healthcare technology may be slow to disseminate due to patient and provider related factors.