PDF(Pubmed)
Abstract：
To describe the prevalence of blood pressure (BP) screening according to the 2017 American Academy of Pediatrics (AAP) guidelines and differences according to social vulnerability indicators.
We extracted electronic health record data from January 1, 2018, through December 31, 2018, from the largest healthcare system in Central Massachusetts. Outpatient visits for children aged 3-17 years without a prior hypertension diagnosis were included. Adherence was defined by the American Academy of Pediatrics guideline (≥1 BP screening for children with a body mass index [BMI] of <95th percentile) and at every encounter for children with a BMI of ≥95th percentile). Independent variables included social vulnerability indicators at the patient level (insurance type, language, Child Opportunity Index, race/ethnicity) and clinic level (location, Medicaid population). Covariates included child\'s age, sex, and BMI status, and clinic specialty, patient panel size, and number of healthcare providers. We used direct estimation to calculate prevalence estimates and multivariable mixed effects logistic regression to determine the odds of receiving guideline-adherent BP screening.
Our sample comprised 19 695 children (median age, 11 years; 48% female) from 7 pediatric and 20 family medicine clinics. The prevalence of guideline-adherent BP screening was 89%. In our adjusted model, children with a BMI of ≥95th percentile, with public insurance, and who were patients at clinics with larger Medicaid populations and larger patient panels had a lower odds of receiving guideline-adherent BP screening.
Despite overall high adherence to BP screening guidelines, patient- and clinic-level disparities were identified.
We extracted electronic health record data from January 1, 2018, through December 31, 2018, from the largest healthcare system in Central Massachusetts. Outpatient visits for children aged 3-17 years without a prior hypertension diagnosis were included. Adherence was defined by the American Academy of Pediatrics guideline (≥1 BP screening for children with a body mass index [BMI] of <95th percentile) and at every encounter for children with a BMI of ≥95th percentile). Independent variables included social vulnerability indicators at the patient level (insurance type, language, Child Opportunity Index, race/ethnicity) and clinic level (location, Medicaid population). Covariates included child\'s age, sex, and BMI status, and clinic specialty, patient panel size, and number of healthcare providers. We used direct estimation to calculate prevalence estimates and multivariable mixed effects logistic regression to determine the odds of receiving guideline-adherent BP screening.
Our sample comprised 19 695 children (median age, 11 years; 48% female) from 7 pediatric and 20 family medicine clinics. The prevalence of guideline-adherent BP screening was 89%. In our adjusted model, children with a BMI of ≥95th percentile, with public insurance, and who were patients at clinics with larger Medicaid populations and larger patient panels had a lower odds of receiving guideline-adherent BP screening.
Despite overall high adherence to BP screening guidelines, patient- and clinic-level disparities were identified.
摘要：
目的：根据2017年美国儿科学会（AAP）指南描述血压（BP）筛查的患病率以及根据社会脆弱性指标的差异。
方法：我们从马萨诸塞州中部最大的医疗保健系统中提取了2018年1月1日至2018年12月31日的电子健康记录数据。包括3至17岁无高血压诊断的儿童的门诊就诊。坚持由AAP指南（体重指数[BMI]<95％的儿童进行≥1BP筛查）以及每次遇到BMI≥95％的儿童时）定义。独立变量包括患者级别的社会脆弱性指标(保险类型，语言,儿童机会指数，种族/民族)和诊所级别(位置，医疗补助人口）。协变量包括孩子的年龄，性别,和BMI状态，和诊所专科，患者面板尺寸，以及医疗保健提供者的数量。我们使用直接估计来计算患病率估计值，并使用多变量混合效应逻辑回归来确定接受指南坚持BP筛查的几率。
结果：我们的样本包括19,695名儿童（中位年龄11岁，48％的女性）来自7个儿科和20个家庭医学诊所。遵循指南的BP筛查的患病率为89%。在我们调整后的模型中，BMI≥95%的儿童，公共保险,并且在医疗补助人群和患者组较大的诊所的患者接受指南依从性BP筛查的几率较低.
结论：尽管对BP筛查指南的总体依从性很高，确定了患者和临床水平的差异.
方法：我们从马萨诸塞州中部最大的医疗保健系统中提取了2018年1月1日至2018年12月31日的电子健康记录数据。包括3至17岁无高血压诊断的儿童的门诊就诊。坚持由AAP指南（体重指数[BMI]<95％的儿童进行≥1BP筛查）以及每次遇到BMI≥95％的儿童时）定义。独立变量包括患者级别的社会脆弱性指标(保险类型，语言,儿童机会指数，种族/民族)和诊所级别(位置，医疗补助人口）。协变量包括孩子的年龄，性别,和BMI状态，和诊所专科，患者面板尺寸，以及医疗保健提供者的数量。我们使用直接估计来计算患病率估计值，并使用多变量混合效应逻辑回归来确定接受指南坚持BP筛查的几率。
结果：我们的样本包括19,695名儿童（中位年龄11岁，48％的女性）来自7个儿科和20个家庭医学诊所。遵循指南的BP筛查的患病率为89%。在我们调整后的模型中，BMI≥95%的儿童，公共保险,并且在医疗补助人群和患者组较大的诊所的患者接受指南依从性BP筛查的几率较低.
结论：尽管对BP筛查指南的总体依从性很高，确定了患者和临床水平的差异.
