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

项目摘要 心血管轨迹开始于幼儿期，并贯穿整个生命过程。早期识别和 儿童期心血管疾病（CVD）风险因素的管理有助于改善这些轨迹， 预防成年期CVD危险因素。一个心血管疾病的危险因素，与肥胖结合， 高血压是儿童时期最突出的疾病，在美国，每25个儿童中就有1个受到高血压的影响。健康 与健康的社会决定因素有内在联系的差距（即，孩子们 生活在），坚持高血压的患病率与一贯较高的比率，这种情况下看到的那些 较低的社会经济地位和黑人种族和拉丁裔。美国儿科学会 (AAP)2017年临床实践指南建议定期筛查和随访检测， 高血压的管理。然而，这种情况的诊断是罕见的（约74%未确诊）， 诊断可能性的种族差异，因为白色儿童更有可能患有这种疾病 诊断。了解导致高血压诊断的过程（例如，血压 筛查和随访），因为更新的AAP指南发布，缺乏。因此， 本研究旨在描述儿童血压筛查和随访的现状 根据2017年AAP指南。3-17岁儿童电子健康档案回顾性研究 年从马萨诸塞州纪念医疗保健系统，安全网系统，和最大的非营利健康 在马萨诸塞州中部的医疗系统中，我们将：（1）进行为期一年的患病率研究，以量化 指南依从性血压筛查的患病率和检查差异， 指南一致性治疗;（2）进行队列研究，通过该研究我们将描述累积发生率 高血压的诊断后遵循指南的后续行动和缺乏收到的差异 指导方针一致的照顾;和（3）进行定性研究，通过我们将描述提供者的 儿科血压筛查临床实践指南的经验和看法， 随访通过目前的工作，它是假设，不公平的照顾，异质性的后续行动， 将确定指南遵守的挑战，以告知未来改进临床实践指南的努力 吸收和儿科预防保健。在大学强大的学术环境的支持下， 马萨诸塞州医学院，并严格，量身定制的培训计划，这F31将定位古尔丁女士， 成为一名独立的调查员，解决青年人之间的心血管疾病健康差距。

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.