Evaluation of Treatments and Services to People with Duchenne Muscular Dystrophy

总的来说，杜氏肌营养不良症（DMD）和较轻的等位变异贝克肌营养不良症（BMD）是最常见的隐性肌营养不良症。据估计，DMD的出生患病率为1 / 3,500(2.9 / 10,000)，骨密度为1 / 18,518（0.5 / 10,000）。DBMD是累及多个系统的进行性疾病，包括肌肉、骨骼、呼吸和心血管系统。此外，社会、认知和心理发展也会受到疾病的负面影响。因此，一个全面的，多学科的方法来照顾个人与DMD是最佳的。为了促进这种护理，已经制定了针对DMD患者的治疗和服务建议，包括美国神经病学学会和儿童神经病学学会关于皮质类固醇治疗的建议，美国胸科学会关于呼吸护理的建议，美国儿科学会关于心脏监测的建议，以及最近，由DMD护理专家小组制定并由美国疾病控制和预防中心（CDC）协调的《2010年关于整体护理的护理考虑》。在过去的十年中，肌萎缩症监测跟踪和研究网络（MD STARnet）对DBMD进行了积极的、基于人群的监测，以表征DBMD的流行病学特征，并在亚利桑那州、科罗拉多州、爱荷华州和纽约州西部的四个地点对DBMD患儿进行了长期随访和跟踪。对于目前的项目，我们建议利用和更新MD STARnet收集的数据，系统地评估为DMD患者提供的治疗和服务之间的一致性，并将接受的治疗与2010年DMD护理注意事项中记录的建议进行比较。这将确定建议的护理标准与实际得到的护理之间的差距。此外，我们将调查MD STARnet确定的卫生保健提供者，以确定在提供治疗和服务方面涉及的障碍和挑战。MD STARnet的四个站点所涵盖的地理区域反映了美国DMD患者的社会人口特征。虽然国际上正在努力检查DMD推荐治疗的吸收情况（例如，TREAT-NMD，加拿大儿科神经肌肉组），但在美国还没有进行类似的努力。我们提议的项目将允许在美国以人群为基础的DMD患者样本中对DMD护理考虑因素的实施进行比较评估。该项目有可能对公共卫生产生重大影响，因为它评估了对保健考虑因素的吸收情况，并确定了可能阻碍向DMD患者提供所推荐的保健服务的障碍。研究结果的传播将使致力于DMD的卫生保健提供者了解实际护理和推荐护理之间的潜在差异，并提供减少这些差异的潜在解决方案。

DESCRIPTION (provided by applicant): Project Summary Taken together, Duchenne muscular dystrophy (DMD) and the milder allelic variant Becker muscular dystrophy (BMD) are the most common recessive form of muscular dystrophy. The birth prevalence of DMD has been estimated at 1 in 3,500 (2.9 per 10,000) male births and BMD at 1 in 18,518 (0.5 per 10,000) male births. DBMD are progressive diseases that affect multiple systems including muscular, skeletal, respiratory, and cardiovascular. In addition, social, cognitive and psychological development can be negatively affected by the disease. As a result, a comprehensive, multidisciplinary approach to the care of individuals with DMD is optimal. In order to promote such care, recommendations for treatments and services for individuals with DMD have been developed and include those by the American Academy of Neurology and Child Neurology Society on corticosteroid treatment, American Thoracic Society on respiratory care, American Academy of Pediatrics on cardiac surveillance recommendations and, more recently, the 2010 Care Considerations on whole care developed by panels of experts in the care of DMD and coordinated by the US Centers for Disease Control and Prevention (CDC). Over the past decade, the Muscular Dystrophy Surveillance Tracking and Research Network (MD STARnet) has conducted active, population-based surveillance of DBMD to characterize the epidemiology and develop long-term follow-up and tracking of children with DBMD across four sites in Arizona, Colorado, Iowa, and western New York. For the current project, we propose to utilize and update data collected by the MD STARnet to systematically evaluate agreement between treatments and services provided to individuals who have DMD and compare treatment received to the recommendations documented in the 2010 DMD Care Considerations. This will identify gaps between recommended standards of care and actual care received. Additionally, we will survey health care providers identified by the MD STARnet to identify barriers and challenges involved in the delivery of treatments and services. The geographical area covered by the four sites of the MD STARnet mirrors the socio-demographic characteristics of people with DMD in the United States. Although international efforts to examine the uptake of recommended care in DMD are underway (e.g., TREAT-NMD, Canadian Pediatric Neuromuscular group), similar efforts have not been undertaken in the United States. Our proposed project will allow a comparative evaluation of the implementation of the DMD Care Considerations in a population-based sample of individuals with DMD within the US. This project has the potential of having a major public health impact by evaluating the uptake of care considerations and identifying barriers that may prevent the delivery of recommended health care to individuals with DMD. The dissemination of the findings will inform health care providers dedicated to DMD of the potential disparities between actual and recommended care and provide potential solutions for reducing these discrepancies.