Evidence-based Detection of Pediatric Obstructive Sleep Apnea

项目摘要/摘要 据估计，美国有220万儿童患有阻塞性睡眠呼吸暂停(OSA)。尽管有证据指南- 在诊断和管理的基础上，许多儿童继续生活在不治疗的负面后果中 奥萨。研究表明，只有不到25%的有OSA症状的儿童得到了适当的评估和 管理层。来自种族和少数民族群体以及经济资源较少的儿童， 更不可能得到儿童阻塞性睡眠呼吸暂停的及时循证诊断和护理。因此，有一个 迫切需要额外的战略来促进对儿童阻塞性睡眠呼吸暂停综合征的循证检测。 这项研究的总体目标是：(I)开发一种积极参与的健康沟通信息 通过告知父母其子女患阻塞性睡眠呼吸暂停综合症的风险；以及(Ii)确定其对阻塞性睡眠呼吸暂停综合征检测的影响。这个 健康通信信息将作为现有计算机决策支持系统的一部分实施，以 OSA(CHICA OSA)，包括自动OSA筛查和对初级保健提供者(PCP)的提示。 具体目标如下： 具体目标1：为孩子的父母制定并反复提炼健康沟通信息 OSA筛查呈阳性。利益相关者(例如，家长、初级保健医生、睡眠医学专家)将参与 消息的创建和迭代提炼。母公司利益相关者将代表所服务的人群 在我们的诊所里，主要是拥有医疗补助保险的黑人、白人西班牙裔和非拉美裔白人家庭。这 在与PCP会面之前，将向OSA筛查呈阳性的儿童的父母传递信息， 鼓励家长：(I)与儿科专科医生讨论OSA；及(Ii)参加转介预约。 具体目的2：评估健康沟通信息对OSA检测的影响。家长 CHICA OSA筛查呈阳性的儿童将随机接受健康检查 通信消息或无附加信息(控制)。我们假设父母被随机分配到 消息将更有可能完成OSA转介预约(主要结果)。 这项研究将确定改进儿童阻塞性睡眠呼吸暂停综合征检测的策略，重点是人群 在医疗保健研究中代表性不足，发现率最低。申请者的职业目标是 成为制定和评估促进循证战略的专家和领导者 初级保健中儿童睡眠障碍的识别和管理，重点是计算机决策 支持(信息学)。这项NHLBI K23奖包括以下领域的额外培训：(I)传播 和实施研究。和(Ii)健康信息学。将开展培训和研究活动 在印第安纳大学医学院。

PROJECT SUMMARY / ABSTRACT Obstructive sleep apnea (OSA) affects an estimated 2.2 million US children. Despite guidelines for evidence- based diagnosis and management, many children continue to live with the negative consequences of untreated OSA. Studies suggest fewer than 25% of children with OSA symptoms receive appropriate evaluation and management. Children from racial and ethnic minority groups, as well as those with fewer economic resources, are even less likely to receive timely evidence-based diagnosis and care for pediatric OSA. Thus, there is a critical need for additional strategies to promote evidence-based detection of pediatric OSA. The overall objective of this research is to: (i) to develop a health communication message that actively engages parents by informing them of their child’s risk for OSA; and (ii) to determine its impact on OSA detection. The health communication message will be implemented as part of an existing computer decision support system for OSA (CHICA OSA), which includes automated OSA screening and prompts to primary care providers (PCPs). Specific aims are as follows: SPECIFIC AIM 1: Develop and iteratively refine a health communication message for parents of children with a positive OSA screen. Stakeholders (e.g., parents, PCPs, sleep medicine specialists) will be engaged in the creation and iterative refinement of the message. Parent stakeholders will represent the populations served in our clinics, primarily black, white Hispanic, and white Non-Hispanic families with Medicaid insurance. This message will be delivered to parents of children with a positive OSA screen prior to meeting with the PCP, with the goal of encouraging parents to: (i) discuss OSA with the PCP; and (ii) attend referral appointments. SPECIFIC AIM 2: Evaluate the impact of the health communication message on OSA detection. Parents of children who screen positive for OSA within CHICA OSA will be randomized to receive the health communication message or no additional information (control). We hypothesize that parents randomized to the message will be more likely to complete an OSA referral appointment (primary outcome). This study will identify strategies to improve detection of pediatric OSA, with a focus on populations underrepresented in healthcare research with the lowest detection rates. The applicant’s career goal is to become an expert and leader in the development and evaluation of strategies that promote evidence-based identification and management of pediatric sleep disorders in primary care, with a focus on computer decision support (informatics). This NHLBI K23 award includes additional training in the following areas: (i) dissemination and implementation research. and (ii) health informatics. Training and research activities will be conducted at the Indiana University School of Medicine.