Design of a randomized clinical trial to improve rates of amblyopia detection in preschool aged children in primary care settings.
Design of a randomized clinical trial to improve rates of amblyopia detection in preschool aged children in primary care settings.
复制标题
设计一项随机临床试验，以提高初级保健机构中学龄前儿童的弱视检出率。
DOI：
10.1016/j.cct.2010.10.009
复制
发表时间：
2011
影响因子：
2.2
通讯作者：
Hartmann,EEugenie
中科院分区：
文献类型：
--
作者：
Wall,TerryC;Marsh-Tootle,WendyL;Crenshaw,Katie;Person,SharinaD;Datla,Raju;Kristofco,RobertE;Hartmann,EEugenie
目的提出一项整群随机对照试验 (cRCT) 的设计，以评估基于网络的干预措施的有效性，以提高提供者对斜视和弱视 (S/A) 以及学前视力筛查 (PVS) 的了解，提高 PVS 率，并提高眼科专家做出的 S/A 诊断率。这是第一个针对弱视预防的 cRCT。 方法 参与者是阿拉巴马州、南卡罗来纳州或伊利诺伊州的医疗补助提供者，他们可以访问互联网，并且在入组前的 12 个月内为 3 岁或 4 岁的儿童提交了至少 8 份健康儿童就诊 (WCV) 申请。干预组（视力）或对照组（血压）的随机化发生在集群水平，定义为提供者（或提供者组）及其接受 WCV 的患者。结果 65 名干预提供者 (IP) 涉及 3547 名 3 岁或 4 岁儿童，71 名对照提供者 (CP) 涉及 5053 名儿童。该研究将根据网络数据报告知识测量和自我报告的视力筛查行为。主要结果将是 PCP 中的 PVS 率，以及属于控制和干预实践的儿童中眼科专家对 S/A 的诊断率。 结论 我们在招募 PCP 时遇到了与其他人报告的同样的困难。 PVS 的基线发生率较低（14.1%），眼科医师诊断出 S/A 的比率也较低（1.4%）。我们的数据表明需要改进这两项主要结果指标。
PURPOSETo present the design of a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a web-based intervention for improving provider knowledge about strabismus and amblyopia (S/A) and preschool vision screening (PVS), increase PVS rates, and improve rates of S/A diagnoses made by eye specialists. This is the first cRCT targeting amblyopia prevention.METHODSParticipants were Medicaid providers in AL, SC, or IL who had Internet access and had filed at least 8 claims for well child visits (WCV) for children ages 3 or 4years old during a 12-month period before enrollment. Randomization to the Intervention (vision) or Control (blood pressure) arm occurred at the cluster level, defined as the provider (or group of providers) and his/her patients seen for WCVs.RESULTS65 Intervention providers (IPs) with 3547 children aged 3 or 4years, and 71 Control providers (CPs) with 5053 children enrolled. The study will report measures of knowledge and self-reported vision screening behaviors from web-based data. The primary outcomes will be rates of PVS among PCPs, and rates of diagnosis of S/A by eye specialists among the children belonging to Control and Intervention practices.CONCLUSIONSWe had the same difficulty recruiting PCPs as reported by others. Baseline rates of PVS were low (14.1%), as were rates that S/A were diagnosed by eye providers (1.4%). Our data show a need to improve both primary outcome measures.