PDF(Pubmed)
Abstract：
To describe adherence to the American Academy of Pediatrics\' (AAP) 2017 clinical practice guidelines for follow-up after high blood pressure (BP) screening by pediatric and family medicine providers in a Massachusetts health care system and to assess differences in receipt of follow-up according to child- and clinic-level factors.
Electronic health record data were analyzed for children aged 3 to 17years who had an outpatient primary care visit during 2018 with a high BP screening (according to AAP guidelines). We classified AAP guideline adherent follow-up as BP follow-up within 6months after an elevated finding (+2-week buffer) and within 2weeks after a hypertensive finding (+2-week buffer). Differences in receipt of guideline adherent follow-up by child- and clinic-level factors were assessed via multilevel mixed effects logistic regression models.
The median age of the 4563 included children was 12years and 43% were female. Overall, guideline adherent follow-up was received by 17.7% of children within the recommended time interval; 27.4% for those whose index BP was elevated and 5.4% for those whose index BP was hypertensive. Modeling revealed older children and those belonging to clinics with more providers, smaller patient panels, and smaller proportion of Medicaid patients were more likely to receive adherent follow-up.
Few children received guideline adherent BP follow-up and most differences in adherence were related to clinic resources. System-level interventions are needed to improve BP follow-up.
Electronic health record data were analyzed for children aged 3 to 17years who had an outpatient primary care visit during 2018 with a high BP screening (according to AAP guidelines). We classified AAP guideline adherent follow-up as BP follow-up within 6months after an elevated finding (+2-week buffer) and within 2weeks after a hypertensive finding (+2-week buffer). Differences in receipt of guideline adherent follow-up by child- and clinic-level factors were assessed via multilevel mixed effects logistic regression models.
The median age of the 4563 included children was 12years and 43% were female. Overall, guideline adherent follow-up was received by 17.7% of children within the recommended time interval; 27.4% for those whose index BP was elevated and 5.4% for those whose index BP was hypertensive. Modeling revealed older children and those belonging to clinics with more providers, smaller patient panels, and smaller proportion of Medicaid patients were more likely to receive adherent follow-up.
Few children received guideline adherent BP follow-up and most differences in adherence were related to clinic resources. System-level interventions are needed to improve BP follow-up.
摘要：
目的：描述美国儿科学会（AAP）2017年临床实践指南的遵守情况，以便马萨诸塞州医疗保健系统中儿科和家庭医学提供者进行高血压（BP）筛查后进行随访，并根据儿童和临床水平的因素评估接受随访的差异。
方法：分析了3至17岁儿童的电子健康记录数据，这些儿童在2018年期间进行了门诊初级保健就诊，并进行了高BP筛查（根据AAP指南）。我们将AAP指南坚持随访分类为血压随访，在升高的发现（2周缓冲）后6个月内和高血压发现（2周缓冲）后2周内。通过多水平混合效应逻辑回归模型评估儿童和临床水平因素在接受指南坚持随访方面的差异。
结果：4563名儿童的中位年龄为12岁，43%为女性。总的来说,17.7％的儿童在推荐的时间间隔内接受了指南坚持随访；BP指数升高的儿童为27.4％，BP指数为高血压的儿童为5.4％。建模显示年龄较大的孩子和那些有更多提供者的诊所的孩子，较小的患者小组，较小比例的医疗补助患者更有可能接受随访。
结论：很少有儿童接受遵循指南的BP随访，依从性的大多数差异与临床资源有关。需要系统层面的干预措施来改善BP后续行动。
方法：分析了3至17岁儿童的电子健康记录数据，这些儿童在2018年期间进行了门诊初级保健就诊，并进行了高BP筛查（根据AAP指南）。我们将AAP指南坚持随访分类为血压随访，在升高的发现（2周缓冲）后6个月内和高血压发现（2周缓冲）后2周内。通过多水平混合效应逻辑回归模型评估儿童和临床水平因素在接受指南坚持随访方面的差异。
结果：4563名儿童的中位年龄为12岁，43%为女性。总的来说,17.7％的儿童在推荐的时间间隔内接受了指南坚持随访；BP指数升高的儿童为27.4％，BP指数为高血压的儿童为5.4％。建模显示年龄较大的孩子和那些有更多提供者的诊所的孩子，较小的患者小组，较小比例的医疗补助患者更有可能接受随访。
结论：很少有儿童接受遵循指南的BP随访，依从性的大多数差异与临床资源有关。需要系统层面的干预措施来改善BP后续行动。
