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Improving Universal Pediatric Lipid Screening
Kathleen DeSantes1, Ann Dodge2, Jens Eickhoff3
1Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Insights
Pediatricians significantly increased universal lipid screening after national guidelines, electronic health record (EHR) modifications, and education. Targeting adolescents aged 12-16 improved screening rates, showing these strategies enhance guideline adherence.
Area of Science:
- Pediatric Health
- Preventive Medicine
- Public Health
Background:
- Universal lipid screening in children is recommended by national guidelines.
- Adherence to these guidelines has historically been suboptimal.
- Identifying effective strategies to improve screening practices is crucial for early detection of dyslipidemia.
Purpose of the Study:
- To assess the impact of national guidelines, electronic health record (EHR) modifications, and educational initiatives on pediatricians' universal lipid screening practices.
- To determine the correlation between these interventions and changes in screening prevalence over time.
Main Methods:
- A retrospective review of electronic health records (EHRs) from an academic general pediatric practice was conducted.
- The study analyzed lipid screening order placement for 22,374 patients aged 9-21 years between January 2010 and December 2015.
- Prevalence data were compared with the timing of guideline releases, educational programs, and EHR system changes.
Main Results:
- Lipid screening order placement increased from 8.9% to 50.0% over the study period (P < .001).
- Significant increases in screening were observed across all age groups following guideline publications, educational initiatives, and EHR modifications (P < .0001).
- The composite prevalence of screening, accounting for order placement and completion, reached 46.8%.
Conclusions:
- Educational initiatives and EHR modifications can substantially improve adherence to universal lipid screening recommendations.
- Expanding screening targets to include adolescents aged 12-16 years, in addition to recommended age groups, enhanced screening prevalence.
- These strategies offer a scalable model for implementing other clinical guidelines in pediatric practice.
Objective:
To evaluate whether the release of national guidelines, electronic health record (EHR) modifications, and educational initiatives correlated with changes in pediatricians' universal lipid screening practices.
Study Design:
Retrospective review of EHRs in an academic general pediatric practice was performed to measure the prevalence of order placement. A child was "screened" if an order was placed during a well-visit between 9 and 21 years of age. The prevalence of order placement for lipid screens on 22 374 patients from January 2010 to December 2015 was analyzed for date of order and patient age, then compared with timing of guidelines, local educational initiatives, and EHR modifications. Primary study outcome was lipid screening order placement over time.
Results:
Order placement increased from 8.9% (95% CI 8.3%-9.5%) before any intervention to 50.0% (95% CI 48.8%-51.2%) over the last 12 months of the study period (P < .001). All age groups showed significant increases in order placement. Changes in screening were seen following guideline publications, educational initiatives, and EHR modifications (for all, P < .0001). Order completion was 69.6% (95% CI 68.9%-70.3%). The composite prevalence of screening (order placement multiplied by order completion) was 46.8% over the 6-year study period.
Conclusions:
Improved adherence to recommendations for universal lipid screening is possible through educational initiatives and EHR modifications. Inclusion of 12- to 16-year-old adolescents/teenagers as a targeted group for universal screening in addition to recommended age groups improved screening prevalence. Similar efforts could be applicable for implementation of other guidelines.
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