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

项目总结 心血管疾病的轨迹开始于儿童早期，并贯穿整个生命过程。及早识别和 对儿童心血管疾病(CVD)危险因素的管理有助于改善这些轨迹和 预防成年后心血管疾病的危险因素。与肥胖一起增加的一个心血管疾病风险因素 儿童时期的突出症状是高血压，在美国，每25个儿童中就有一个受到高血压的影响。健康状况 与健康的社会决定因素有内在联系的差距(即儿童 生活)，坚持高血压的患病率，这种情况的发生率在那些 较低的社会经济地位以及黑人和拉丁裔的社会经济地位。美国儿科学会 (AAP)2017临床实践指南建议定期筛查和随访检测和 高血压的管理。然而，这种情况的诊断很少见(~74%未诊断)，而且有 由于白人儿童更有可能患上这种疾病，诊断的可能性存在种族差异 诊断出来了。了解导致诊断高血压(例如，血压)的过程 自最新的AAP指南发布以来，缺乏筛查和后续行动)。因此，目标是 本调查旨在描述儿童血压筛查和随访的现状。 根据2017年AAP指南。对3-17岁儿童使用回溯性电子健康记录数据 加州大学马萨诸塞州纪念医疗保健系统，一个安全网系统，以及最大的非营利性医疗保健 在马萨诸塞州中部的护理系统，我们将：(1)进行一项为期一年的患病率研究，以量化 遵守指南的血压筛查的流行率和检查缺乏收据的差异 指导方针一致性护理；(2)进行一项队列研究，通过该研究，我们将描述累积发病率 在检测到高血压和缺乏接受治疗的差异后遵守指南的随访 指导方针一致性护理；以及(3)进行定性研究，通过该研究，我们将描述提供者的 儿科血压筛查和临床操作指南的体会和体会 后续行动。通过目前的工作，假设护理中的不平等、随访中的异质性以及 将确定遵守指南的挑战，以便为未来改进临床实践指南的努力提供信息 摄取和儿科预防性护理。由密歇根大学稳健的学术环境支持 以及严格的、量身定制的培训计划，这款F31将使古尔丁女士 成为解决青年心血管疾病健康差距的独立调查者。

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.