Overcoming Disparities in Growth Evaluations

克服增长评估的差异

• 批准号: 8103163
• 负责人: ADDA GRIMBERG
• 金额: $ 52.8万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8103163
• 关键词: 2 year old; 21 year old; Academy; Address; Adolescence; Affect; American; Area; Attitude; Belief; Caring; Celiac Disease; Child; Child health care; Childhood; Clinic; Collection; Congresses; Consultations; Country; Data; Delaware; Diagnosis; Diagnostic; Diagnostic tests; Differential Diagnosis; Disease; Education; Electronic Health Record; Electronics; Endocrine; Endocrinologist; Evaluation; Failure; Family; Female; Gender; Goals; Growth; Health; Healthcare; Height; Hormonal; Intervention; Lead; Literature; Measures; Methods; Minority; Minority Groups; Morbidity - disease rate; New Jersey; Outcome; Parents; Pathology; Patients; Pediatrics; Pennsylvania; Perception; Physician' s Practice Patterns; Plant Roots; Population; Preventive; Primary Health Care; Prospective Studies; Qualifying; Recommendation; Registries; Research; Role; Shapes; Socioeconomic Factors; Somatotropin; Specialist; System; Turner' s Syndrome; Underrepresented Minority; United States Food and Drug Administration; United States National Institutes of Health; Variant; Visit; Weight; boys; design; efficacy testing; expectation; girls; growth hormone deficiency; health disparity; improved; male; minority health; mortality; novel; novel strategies; pediatrician; pressure; programs; r-hGH-M; social; socioeconomics; tool

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Growth faltering is often the first or only sign of an underlying health problem in a child. However, due to social pressures for tallness, there are gender, racial and socioeconomic disparities in the children who receive specialist evaluation and growth hormone treatment. This study aims to understand the roots of those disparities - from the perspectives of both the primary care pediatricians and the parents - and to test the efficacy of an electronic alert and decision support tool in improving the consistency of pediatrician diagnostic testing and specialist referral for growth faltering.

描述(申请人提供)：生长发育是儿童整体健康的敏感标志。尽管身材矮小通常是正常生长的一种表现形式，但仅凭生长发育迟缓就会出现多种疾病。因此，对生长迟缓的及时评估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，这是第一个强调身高而不是潜在病理作为治疗合格标准的适应症。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，寻求内分泌咨询以评估发育迟缓的儿童也是如此。在评估和治疗发育迟缓方面的性别、种族和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进行社会驱动的身高增加，以及在诊断种族和社会经济少数群体的女孩和儿童的潜在疾病方面可能出现不必要的延误。这项拟议的研究将从两个新的角度--初级保健儿科医生(PCP)和患者家庭--评估在管理增长步履蹒跚方面的差异。生长研究传统上集中在内分泌中心或生长激素注册中心的受限人群上，这些中心或生长激素注册中心受到确证偏差的困扰。通过利用强大的技术进步-电子健康记录(EHR)系统，拟议的研究将涵盖覆盖新泽西州、宾夕法尼亚州和特拉华州的人口结构不同的初级保健儿科网络中所有2岁至15岁(女孩)或17岁(男孩)的儿童。这项研究旨在评估PCP对发育迟缓儿童的识别和评估方法，并测试电子警报和决策支持工具在提高PCP生长评估的一致性方面的有效性。然而，PCP的管理往往受到患者家属的担忧和期望的影响。因此，这项研究还旨在了解患者家庭在造成增长停滞的管理方面的差异方面所起的互补作用。采用定性和定量相结合的方法，这项研究将从父母自己那里得出影响他们因发育迟缓而获得评估和治疗的可能性的因素，并分析性别、种族和社会经济因素如何与这种可能性相关联。只有了解差距的根源，才能制定有效的战略来消除差距。这项研究符合国会在2000年《少数民族健康和健康差距研究和教育法》中授权的NIH减少并最终消除健康差距的目标，以及PA-07-392减少少数群体和未得到充分服务的儿童的健康差距的目标。除了发育不平衡这一具体问题之外，这项研究还可能通过展示电子健康记录在塑造医生执业模式方面的力量，显著影响儿科护理和儿童健康。与公共健康相关：发育迟缓往往是儿童潜在健康问题的第一个或唯一迹象。然而，由于社会对身高的压力，接受专家评估和生长激素治疗的儿童存在性别、种族和社会经济差异。这项研究旨在从初级保健儿科医生和家长的角度了解这些差异的根源，并测试电子警报和决策支持工具在改善儿科医生诊断测试和专家转诊对发育迟缓的一致性方面的有效性。