Abstract：
BACKGROUND: Individuals with sickle cell disease (SCD) at increased risk for stroke should undergo annual stroke risk assessment using transcranial Doppler (TCD) screening between the ages of 2 and 16. Though this screening can significantly reduce morbidity associated with SCD, screening rates at Boston Children\'s Hospital (and nationwide) remain below the recommended 100% screening adherence rates.
METHODS: Three plan-do-study-act (PDSA) cycles were designed and implemented. The Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) aim of our quality improvement (QI) initiative was to sustainably increase the proportion of eligible patients receiving a TCD within 15 months of their last TCD to greater than 95%. An interrupted time series (ITS) analysis was performed, comparing TCD adherence rates from PDSA Cycle 1 to those from PDSA Cycles 2 and 3.
RESULTS: Mean TCD adherence increased across all three PDSA cycles, from a baseline of 67% in the first cycle (January 2015 to September 2020) to 92% in the third cycle (May 2021 to March 2023). In the ITS analysis of TCD adherence rates, there was a significant difference in the final TCD adherence rate achieved compared to the rate predicted, with a total estimated increase in adherence of 17.9% being attributable to the interventions from PDSA Cycles 2 and 3.
CONCLUSIONS: Although other QI initiatives had demonstrated ability to increase adherence to TCD screening for patients with SCD, this is the first QI project to collect data over such a prolonged period of time to demonstrate a sustained increase in screening rates throughout the intervention (an 8-year period).
METHODS: Three plan-do-study-act (PDSA) cycles were designed and implemented. The Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) aim of our quality improvement (QI) initiative was to sustainably increase the proportion of eligible patients receiving a TCD within 15 months of their last TCD to greater than 95%. An interrupted time series (ITS) analysis was performed, comparing TCD adherence rates from PDSA Cycle 1 to those from PDSA Cycles 2 and 3.
RESULTS: Mean TCD adherence increased across all three PDSA cycles, from a baseline of 67% in the first cycle (January 2015 to September 2020) to 92% in the third cycle (May 2021 to March 2023). In the ITS analysis of TCD adherence rates, there was a significant difference in the final TCD adherence rate achieved compared to the rate predicted, with a total estimated increase in adherence of 17.9% being attributable to the interventions from PDSA Cycles 2 and 3.
CONCLUSIONS: Although other QI initiatives had demonstrated ability to increase adherence to TCD screening for patients with SCD, this is the first QI project to collect data over such a prolonged period of time to demonstrate a sustained increase in screening rates throughout the intervention (an 8-year period).
摘要：
背景：卒中风险增加的镰状细胞病（SCD）患者应在2至16岁之间使用经颅多普勒（TCD）筛查进行年度卒中风险评估。虽然这种筛查可以显著降低与SCD相关的发病率，波士顿儿童医院(及全国)的筛查率仍低于推荐的100%筛查依从率.
方法：设计并实施了三个计划-做-研究-行为（PDSA）周期。具体的,可测量,可成就,相关,我们的质量改进（QI）计划的时间限制（SMART）目标是在上一次TCD后的15个月内，将接受TCD的合格患者比例持续增加到95％以上。进行了中断时间序列(ITS)分析，比较PDSA第1周期与PDSA第2周期和第3周期的TCD依从率。
结果：在所有三个PDSA周期中，平均TCD依从性增加，从第一个周期（2015年1月至2020年9月）的67％的基线到第三个周期（2021年5月至2023年3月）的92％。在ITS对TCD依从性的分析中，与预测的比率相比，最终的TCD依从率存在显着差异，依从性估计总共增加了17.9%，这归因于PDSA周期2和3的干预措施。
结论：尽管其他QI计划已证明能够提高SCD患者对TCD筛查的依从性，这是第一个在如此长的时间内收集数据的QI项目,以证明在整个干预期间(为期8年)筛查率持续增加.
方法：设计并实施了三个计划-做-研究-行为（PDSA）周期。具体的,可测量,可成就,相关,我们的质量改进（QI）计划的时间限制（SMART）目标是在上一次TCD后的15个月内，将接受TCD的合格患者比例持续增加到95％以上。进行了中断时间序列(ITS)分析，比较PDSA第1周期与PDSA第2周期和第3周期的TCD依从率。
结果：在所有三个PDSA周期中，平均TCD依从性增加，从第一个周期（2015年1月至2020年9月）的67％的基线到第三个周期（2021年5月至2023年3月）的92％。在ITS对TCD依从性的分析中，与预测的比率相比，最终的TCD依从率存在显着差异，依从性估计总共增加了17.9%，这归因于PDSA周期2和3的干预措施。
结论：尽管其他QI计划已证明能够提高SCD患者对TCD筛查的依从性，这是第一个在如此长的时间内收集数据的QI项目,以证明在整个干预期间(为期8年)筛查率持续增加.
