Evidence-based Detection of Pediatric Obstructive Sleep Apnea

项目总结/摘要 据估计，阻塞性睡眠呼吸暂停（OSA）影响着220万美国儿童。尽管有证据准则- 尽管有基于诊断和管理的治疗，许多儿童仍然生活在未经治疗的不良后果中。 阻塞性睡眠呼吸暂停综合症。研究表明，只有不到25%的患有OSA症状的儿童接受了适当的评估， 管理少数种族和族裔群体的儿童以及经济资源较少的儿童， 更不可能得到及时的基于证据的诊断和治疗小儿OSA。因此，有一个 迫切需要额外的策略，以促进儿童OSA的循证检测。 本研究的总体目标是：（i）制定积极参与的健康传播信息 通过告知父母他们的孩子患阻塞性睡眠呼吸暂停综合症的风险;及（ii）确定其对阻塞性睡眠呼吸暂停综合症检测的影响。的 卫生通信信息将作为现有计算机决策支持系统的一部分， 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：为儿童的父母制定并反复完善健康沟通信息 阻塞性睡眠呼吸暂停检查呈阳性利益攸关方（例如，父母，PCP，睡眠医学专家）将参与 消息的创建和迭代细化。上级利益攸关方将代表所服务的人群 在我们的诊所，主要是黑人，白色西班牙裔，和白色非西班牙裔家庭与医疗补助保险。这 在与PCP会面之前，将向OSA筛查呈阳性的儿童的父母传达信息， 鼓励家长：（i）与PCP讨论OSA;以及（ii）参加转诊预约。 具体目标2：评估健康沟通信息对OSA检测的影响。父母 在CHICA OSA中筛查出OSA阳性的儿童将随机接受健康检查， 通信消息或没有附加信息（控制）。我们假设父母随机分配到 消息将更有可能完成OSA转诊预约（主要结局）。 这项研究将确定改善儿童OSA检测的策略，重点关注人群 在医疗保健研究中代表性不足，检测率最低。申请人的职业目标是 成为制定和评估促进循证医学战略的专家和领导者 初级保健中儿科睡眠障碍的识别和管理，重点是计算机决策 支持（信息学）。该NHLBI K23奖项包括以下领域的额外培训： 和实施研究。及（ii）健康资讯学。将开展培训和研究活动 在印第安纳州大学医学院。

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.