From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service.
From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service.
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DOI：
10.1136/bmjopen-2022-063296
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发表时间：
2022-11-25
期刊：
影响因子：
2.9
通讯作者：
Group EI at-risk CP Team
中科院分区：
文献类型：
--
作者：
Davidson SA;Ward R;Elliott C;Harris C;Bear N;Thornton A;Salt A;Valentine J;Group EI at-risk CP Team
报告在全州范围内的三级早期干预 (EI) 服务中实施脑瘫 (CP) 早期检测指南的知识转化策略和结果，并调查社会决定因素对临床服务的影响。回顾性纵向队列研究。西澳大利亚州三级儿科 EI 服务。使用 EI 服务的 EI 临床医生、消费者和儿童。知识转化策略包括消费者观点、临床医生培训和实践社区 (CoP) 指导实施。我们测量了指南实施后转诊人数和年龄、早期检测和干预的变化。不良童年经历 (ACE)、预约缺勤 (DNA) 率、偏远地区和社会经济五分位数被用来通过负二项式（发生率比，IRR）和逻辑回归（优势比，OR）来衡量健康的社会决定因素。 10 名消费者参加了焦点小组，100 名临床医生接受了培训，22 名临床医生建立了每月的 CoP。转介的儿童数量增加了四倍，达到 511 名。转诊时的校正胎龄从中位数 16.1 个月降至 5.1 个月 (p<0.001)，首次预约时的校正胎龄从中值 18.8 个月降至 6.8 个月 (p<0.001)。生活在社会弱势地位的儿童的 DNA 风险最高（五分位数 1 vs 5：IRR 2.2，95%CI 1.1 至 4.6，p=0.037）。接触 ACE 的儿童生活在社会劣势的几率较高（五分位数 1 vs 5，OR=3.8，95% CI 1.4 至 10.0，p=0.007）。偏远地区与 DNA 率或 ACE 评分之间没有发现显着关联。实施策略降低了转诊年龄并改善了早期检测评估的实施。在开发全州早期检测网络时，需要进一步调查社会劣势、DNA 风险和 ACE 评分之间的关联。
To report on knowledge translation strategies and outcomes from the implementation of the early detection guidelines for cerebral palsy (CP) in a state-wide tertiary early intervention (EI) service and investigate the impact of social determinants on clinical services. Retrospective longitudinal cohort study. The Western Australia tertiary paediatric EI service. EI clinicians, consumers and children using the EI service. Knowledge translation strategies including consumer perspectives, clinician training and Communities of Practice (CoP) guided implementation. We measured changes in referral number and age, delivery of early detection and intervention following the implementation of the guidelines. Exposure to adverse childhood experiences (ACEs), appointment non-attendance (DNA) rates, remoteness and socioeconomic quintiles were used to measure social determinants of health using negative binomial (Incidence Rate Ratios, IRR) and logistic regression (Odds Ratios, ORs). Ten consumers participated in Focus Groups, 100 clinicians were trained and 22 clinicians established a monthly CoP. Referrals increased fourfold to 511 children. Corrected gestational age at referral decreased from a median of 16.1 to 5.1 months (p<0.001) and at first appointment from 18.8 to 6.8 months (p<0.001). Children living in social disadvantage had the highest DNA risk (quintile 1 vs 5: IRR 2.2, 95% CI 1.1 to 4.6, p=0.037). Children exposed to ACEs had higher odds of living in social disadvantage (quintile 1 vs 5, OR=3.8, 95% CI 1.4 to 10.0, p=0.007). No significant association was found between remoteness and DNA rate or ACE score. Implementation strategies reduced referral age and improved the delivery of early detection assessments. Further investigation of the association between social disadvantage, DNA risk and ACE score is required in the development of a state-wide early detection network.
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