Adherence to Clinical Practice Guidelines for Screening and Management of Pediatric High Blood Pressure within a Massachusetts Safety-Net Health Care System

遵守马萨诸塞州安全网医疗保健系统内儿童高血压筛查和管理的临床实践指南

• 批准号: 10464844
• 负责人: Melissa Goulding
• 金额: $ 3.4万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10464844
• 关键词: Academy; Address; Adherence; Adolescent; Adult; Affect; American; Area; Atherosclerosis; Attention; Automobile Driving; Awareness; Biological; Black race; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Cerebrovascular Disorders; Child; Childhood; Chronic Disease; Clinic; Clinical; Clinical Data; Clinical Practice Guideline; Cohort Studies; Data; Detection; Diagnosis; Dietary Practices; Disease; Dyslipidemias; Early identification; Electronic Health Record; Ensure; Environment; Ethnic Origin; Ethnic group; Family history of; Frequencies; Functional disorder; Future; Goals; Guideline Adherence; Guidelines; Health; Healthcare; Healthcare Systems; Heart Diseases; Heterogeneity; High Prevalence; Hypertension; Incidence; Interview; Investigation; Knowledge; Latino; Lead; Learning; Left Ventricular Mass; Life; Life Cycle Stages; Link; Low Birth Weight Infant; Low Prevalence; Massachusetts; Metabolic syndrome; Methods; National Heart, Lung, and Blood Institute; Not Hispanic or Latino; Obesity; Overweight; Patients; Pediatrics; Perception; Physical activity; Play; Population; Populations at Risk; Positioning Attribute; Prevalence; Prevalence Study; Preventive care; Primary Health Care; Primary Prevention; Process; Provider; Publications; Race; Reporting; Research Personnel; Risk; Risk Factors; Risk Management; Sleep Disorders; Strategic vision; System; Training; Universities; Update; Visit; Weight Gain; Work; Youth; aged; cardiovascular disorder risk; cardiovascular health; comparison group; early childhood; ethnic health disparity; experience; follow-up; health difference; health disparity; hypertension control; improved; low socioeconomic status; male; medical schools; population based; prevent; racial and ethnic; racial disparity; safety net; screening; screening guidelines; social; social health determinants; uptake

PROJECT SUMMARY Cardiovascular trajectories begin in early childhood and continue across the life course. Early recognition and management of cardiovascular disease (CVD) risk factors in childhood stand to improve these trajectories and prevent CVD risk factors in adulthood. One CVD risk factor which in conjunction with obesity has gained prominence in childhood and which affects about 1 in every 25 children in the U.S is hypertension. Health disparities which are intrinsically linked to social determinants of health (i.e., the circumstances that children live in), persist in the prevalence of hypertension with consistently higher rates of this condition seen in those of lower socioeconomic status and those of Black race and Latino ethnicity. The American Academy of Pediatrics (AAP) 2017 Clinical Practice Guidelines recommend regular screening and follow-up for the detection and management of hypertension. However, diagnosis of this condition is rare (~74% undiagnosed), and there are racial disparities in the likelihood of diagnosis as white children are more likely to have this condition diagnosed. Understanding the processes that lead to a diagnosis of hypertension (e.g., blood pressure screening and follow-up), since the release of the updated AAP guidelines, is lacking. Therefore, the goal of the present investigation is to describe the current state of pediatric blood pressure screening and follow-up according to the 2017 AAP guidelines. Using retrospective electronic health record data for children aged 3-17 years from the UMass Memorial Health Care System, a safety-net system, and the largest non-for profit health care system in Central Massachusetts, we will: (1) conduct a one year period prevalence study to quantify the prevalence of guideline adherent blood pressure screening and examine disparities in lack of receipt of guideline concordant care; (2) conduct a cohort study through which we will describe the cumulative incidence of guideline adherent follow-up after the detection of high blood pressure and disparities in the lack of receipt of guideline concordant care; and (3) conduct a qualitative study through which we will describe providers’ experiences with and perceptions of clinical practice guidelines for pediatric blood pressure screening and follow-up. Through the present work it is hypothesized that inequities in care, heterogeneity in follow-up, and challenges to guideline adherence will be identified to inform future efforts to improve clinical practice guideline uptake and pediatric preventive care. Supported by a robust academic environment at the University of Massachusetts Medical School, and a rigorous, tailored training plan, this F31 will position Ms. Goulding to become an independent investigator addressing CVD health disparities among youth.

项目摘要 心血管轨迹始于幼儿，并继续整个生活。早期认可和 儿童期心血管疾病（CVD）的危险因素的管理以改善这些轨迹和 预防成年后CVD危险因素。与肥胖相结合的一个CVD风险因素已获得 童年时期的突出性，在美国每25名儿童中影响约1个是高血压。健康 与健康的社会决定者本质上相关的差异（即儿童的情况 居住在）中，一直存在着高血压的患病率 降低社会经济地位以及黑人种族和拉丁裔种族的地位。美国儿科学会 （AAP）2017年临床实践指南建议定期筛查和随访以进行检测和 高血压管理。但是，这种情况的诊断很少见（约74％未诊断），并且有 由于白人儿童更有可能患有这种状况，种族差异很可能 诊断。了解导致高血压诊断的过程（例如，血压 由于缺乏更新的AAP指南，因此筛选和随访）缺乏。因此，目标的目标 本研究是描述小儿血压筛查和随访的当前状态 根据2017年AAP指南。使用3-17岁儿童的回顾性电子健康记录数据 距离UMass Memorial Health Care系统，安全网系统和最大的非利润健康 马萨诸塞州中部的护理系统，我们将：（1）进行一年的患病率研究以量化 指南的患病率遵守血压筛查和检查分布 指南协调； （2）进行队列研究，我们将描述累积事件 在发现高血压和差异后，指南的遵守随访 指南协调； （3）进行定性研究，我们将通过该研究来描述提供商 关于小儿血压筛查的临床实践指南的经验和看法 后续。通过目前的工作，可以假设护理中的不平等，随访中的异质性和 将确定对指南依从性的挑战，以告知未来的努力以改善临床实践指南 摄取和小儿预防保健。在大学的强大学术环境的支持下 马萨诸塞州医学院以及严格的，量身定制的培训计划，该F31将把古尔德女士定位为 成为针对年轻人中CVD健康分配的独立调查员。