Implementation of a Process for Initial Transcranial Doppler Ultrasonography in Children With Sickle Cell Anemia.
Implementation of a Process for Initial Transcranial Doppler Ultrasonography in Children With Sickle Cell Anemia.
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DOI：
10.1016/j.amepre.2016.01.021
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发表时间：
2016-07
影响因子：
5.5
通讯作者：
Kalinyak KA
中科院分区：
文献类型：
--
作者：
Crosby LE;Joffe NE;Davis B;Quinn CT;Shook L;Morgan D;Simmons K;Kalinyak KA
中风是镰状细胞性贫血 (SCA) 的一种破坏性并发症，可导致不可逆的脑损伤，并伴有身体和认知缺陷。经颅多普勒超声检查 (TCD) 是一种非侵入性工具，用于识别患有 SCA 的中风风险最高的儿童。国家指南建议从 2 岁开始进行 TCD 筛查，但有研究表明，只有不到一半的幼儿接受了筛查。该项目的目的是使用质量改进方法，将 2013 年 12 月 31 日之前成功完成首次 TCD 的 24-27 个月患者比例从 25% 提高到 75%。质量改进方法（例如流程图、简化故障模式效应分析和计划-实施-研究-行动周期）用于开发和测试流程，以识别合格患者、安排 TCD、为儿童和家庭准备首次 TCD 以及监测结果（即 TCD 协议）。使用合格患者的报告和显示首次成功 TCD（人口指标）的年龄（以月为单位）的图表来跟踪进展情况。截至 2013 年 12 月，100% 符合条件的患者成功完成了初次 TCD 筛查；这种改善在接下来的 20 个月里一直保持着。 2014 年 11 月，进行了韦尔奇单向方差分析。结果显示，2009 年出生的合格患者与干预期间出生的合格患者（2010-2013 年；F[1,11.712]=16.03，p=0.002）的首次 TCD 平均年龄存在统计学显着差异。使用质量改进方法实施 TCD 方案与 SCA 幼儿 TCD 筛查率的提高相关。
Stroke, a devastating complication of sickle cell anemia (SCA), can cause irreversible brain injury with physical and cognitive deficits. Transcranial Doppler ultrasonography (TCD) is a non-invasive tool for identifying children with SCA at highest risk of stroke. National guidelines recommend that TCD screening begin at age 2 years, yet there is research to suggest less than half of young children undergo screening. The purpose of this project was to use quality improvement methods to improve the proportion of patients aged 24–27 months who successfully completed their initial TCD from 25% to 75% by December 31, 2013. Quality improvement methods (e.g., process mapping, simplified failure mode effect analysis, and plan–do–study–act cycles) were used to develop and test processes for identifying eligible patients, scheduling TCDs, preparing children and families for the first TCD, and monitoring outcomes (i.e., TCD protocol). Progress was tracked using a report of eligible patients and a chart showing the age in months for the first successful TCD (population metric). As of December 2013, 100% of eligible patients successfully completed their initial TCD screen; this improvement was maintained for the next 20 months. In November 2014, a Welch’s one-way ANOVA was conducted. Results showed a statistically significant difference between the average age of first TCD for eligible patients born in 2009 and eligible patients born during the intervention period (2010–2013; F[1,11.712]=16.03, p=0.002). Use of quality improvement methods to implement a TCD protocol was associated with improved TCD screening rates in young children with SCA.