Overcoming Disparities in Growth Evaluations

项目总结 生长发育是儿童整体健康状况的敏感标志。尽管矮小的身材经常被解读为 正常生长，多种疾病可能会出现单独的生长停滞。因此，及时评估增长 步履蹒跚可能会产生重要的后果，不仅对最终身高，而且对发病率和死亡率。2003年， 美国食品和药物管理局批准生长激素(GH)治疗特发性矮小，这是第一次 强调身高而不是潜在的病理作为治疗的合格标准的适应症。 几十年的文献支持这样一种观察，即对身高的社会压力优先影响男性。 与此一致，GH登记处显示女性和少数族裔患者的代表性明显不足，如 让寻求内分泌咨询的孩子对成长的评价步履蹒跚。性别、种族和 在评估和治疗增长停滞方面的社会经济差异导致了两个有问题的结果： 在健康的，主要是白人男孩中，不适当地使用生长激素来促进社会驱动的身高增加，以及 在诊断女孩和种族和儿童的潜在疾病方面有可能出现不必要的延误 社会经济上的少数群体。这项拟议的研究将评估在管理增长疲软方面的差距。 从两个新的角度，初级保健儿科医生(PCP)和患者家庭。增长研究已经 传统上专注于受限制的内分泌中心或生长激素注册中心的人群，这些中心或GH注册中心受到困扰 通过确定偏差。通过利用强大的技术进步，电子健康记录 (EHR)系统，拟议的研究将涵盖所有2岁至15岁(女孩)或17岁(男孩)的儿童 人口结构不同的初级保健儿科网络横跨新泽西州、宾夕法尼亚州和 特拉华州。这项研究旨在评估初级保健计划对儿童的识别和评估方法 增长步履蹒跚，测试电子警报和决策支持工具在改善 PCP生长评价的一致性。然而，PCP的管理往往受到患者家属的影响。 担忧和期望。因此，这项研究还旨在了解患者的补充作用- 家庭在制造增长管理方面的差距方面步履蹒跚。使用组合的定性- 通过量化的方法，这项研究将从父母本身引出影响他们患上 获得对增长停滞的评估和治疗，并分析性别、种族和社会经济因素如何 与这种可能性联系在一起。只有了解差距的根源，才能制定有效的战略 旨在消灭他们。这项研究服务于美国国立卫生研究院的目标，由国会授权在少数族裔健康和 2000年健康差距研究和教育法，减少并最终消除健康 此外，还提到了PA-07-392的目标，即减少少数群体和未得到充分服务的儿童之间的健康差距。 除了增长差距不大这一具体问题之外，这项研究还有可能对 通过展示EHR在塑造医生执业模式方面的力量，展示儿科护理和儿童健康。

PROJECT SUMMARY Growth is a sensitive marker of a child's over-all health. Although short stature frequently construes a variant of normal growth, multiple diseases can present with growth faltering alone. Thus, timely evaluation of growth faltering can have important consequences, not just for final height, but for morbidity and mortality. In 2003, the Food and Drug Administration approved growth hormone (GH) treatment for idiopathic short stature, the first indication that emphasizes height rather than underlying pathology as the qualifying criterion for treatment. Decades of literature support the observation that social pressures for tallness preferentially affect males. Consistent with this, GH registries show marked under-representation of female and racial minority patients, as do children who seek endocrine consultations for the evaluation of growth faltering. The gender, racial and socioeconomic disparities in the evaluation and treatment of growth faltering lead to two problematic outcomes: the inappropriate use of GH for socially driven height enhancement in healthy, primarily white boys, and the potential for unnecessary delays in the diagnosis of underlying disease in girls and children of racial and socioeconomic minorities. The proposed study will evaluate disparities in the management of growth faltering from two novel perspectives, the primary care pediatrician (PCP) and the patient-family. Growth studies have traditionally focused on the circumscribed populations of endocrine centers or GH registries, which are beset by ascertainment bias. By taking advantage of a powerful technological advance, the electronic health record (EHR) system, the proposed study will encompass all children aged 2 years to 15 (girls) or 17 (boys) in a demographically heterogeneous primary care pediatrics network that spans New Jersey, Pennsylvania and Delaware. The study seeks to evaluate PCPs' approach to the identification and evaluation of children with growth faltering, and test the efficacy of an electronic alert and decision support tool in improving the consistency of PCP growth evaluations. However, PCP management is often influenced by patient-family concerns and expectations. Thus, the study also aims to understand the complementary role of the patient- family in creating the disparities in the management of growth faltering. Using a combined qualitative- quantitative approach, the study will elicit, from parents themselves, the factors that affect their likelihood to obtain evaluation and treatment for growth faltering and analyze how gender, racial and socioeconomic factors associate with that likelihood. Only by understanding the roots of disparities can effective strategies be designed to eliminate them. This study serves the NIH goal, mandated by Congress in the Minority Health and Health Disparities Research and Education Act of 2000, of reducing and ultimately eliminating health disparities, and the goal of PA-07-392 to reduce health disparities among minority and underserved children. Beyond the specific issue of disparities in growth faltering, this study has the potential to significantly impact pediatric care and child health by demonstrating the power of the EHR in shaping physician practice patterns.