Multi-modal physician intervention to detect amblyopia

描述（由申请人提供）：尽管几十年的研究表明视力异常对神经系统的不良影响，但弱视儿童的情况几乎没有改变。数据显示，大约一半的弱视病例是在晚期发现的，这一发现在过去的40年里一直保持稳定。在我们的卫生保健系统中，初级保健医生在将有关弱视的发现转化为实践方面发挥着关键作用。但是，我们与妇幼卫生局(MCHB) / NEI学龄前儿童视力筛查专家小组和CHB/美国儿科学会（AAP）普遍学前视力筛查项目的经验表明，初级保健医生对弱视及其危险因素的培训很少。因此，许多人没有积极地筛查这些疾病。阿拉巴马大学视光、儿科和继续医学教育系与AAP、MCHB、美国预防失明、儿科眼病调查小组、学龄前儿童视力研究小组和阿拉巴马医疗补助机构合作，提议开发一种新的、基于互联网的多模式策略，以提高儿科医生和办公室初级保健医生对弱视及其危险因素的理解和认识。我们提出了一项随机对照临床试验，以测试我们的干预是否使“干预”医生的表现比对照组医生（暴露于免疫干预）有所提高。我们的设计，以及干预前和干预后的绩效指标，将随着时间的推移，评估干预与其他来源造成的实践变化。我们的最终分析将显示学龄前患者是否更容易被识别为斜视或弱视。这项研究在NEI培养的弱视研究和为美国儿童提供的医疗保健之间建立了一个关键的联系。

DESCRIPTION (provided by applicant): Despite decades of research showing adverse neural consequences of abnormal vision, little has changed for amblyopic children. Data have shown that approximately half the cases of amblyopia are detected late, and this finding has remained stable during the past 40 years. In our health care system, primary care physicians play a pivotal role in translating findings about amblyopia into practice. But, our experience with the Maternal and Child Health Bureau (MCHB) / NEI expert panel on Vision Screening in the Preschool Child and the CHB/American Academy of Pediatrics (AAP) Project Universal Preschool Vision Screening revealed that primary care physicians get very little training about amblyopia and risk factors. Consequently, many do not screen aggressively for these conditions. The University of Alabama Departments of Optometry, Pediatrics and Continuing Medical Education, in collaboration with the AAP, MCHB, Prevent Blindness America, the Pediatric Eye Disease Investigators Group, the Vision in Preschoolers Study Group, and the Alabama Medicaid Agency, propose to develop a novel, internet-based, multi-modal strategy to increase the understanding and recognition of amblyopia and its risk factors by pediatricians and primary care physicians in office based settings. We propose a randomized, controlled clinical trial to test whether our intervention results in improved performance by "intervention" physicians compared to control physicians (exposed to an immunization intervention). Our design, along with pre- and post-intervention performance measures, will evaluate changes in practice attributable to the intervention versus those occurring from other sources over time. Our final analysis will show whether preschool patients of intervention physicians are more likely to be identified with strabismus or amblyopia. This research forges a critical link between the truly phenomenal body of amblyopia research fostered by the NEI and the health care offered to American children.