在儿科初级保健网络中实施心脏突然死亡风险查
Naveed Rabbani1, Margaret Fry2, Louis Vernacchio3
1Pediatric Physicians' Organization at Children's, Wellesley, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Computational Health Informatics Program, Boston Children's Hospital, Boston, MA.
Academic pediatrics
|May 21, 2025
概括
儿科的普遍心脏风险查发现了8.4%的阳性率,但采用和跟踪仍然是挑战,不成比例地影响弱势群体.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 预防医学 预防医学
- 公共卫生 公共卫生
背景情况:
- 美国儿科学会 (AAP) 在2021年更新了针对儿童普遍的,基于病史的突然心脏病死亡风险查的建议.
- 这种扩展的查旨在识别更多的风险人群,而不是以往的历史和考试为基础的方法.
- 了解实施工作流程和系统效应对于在儿科初级保健中广泛采用至关重要.
研究的目的:
- 评估在大型儿科初级保健网络中实施通用心脏风险查的情况.
- 评估查阳性率并确定最佳的工作流程设计.
- 检查潜在的基于系统的影响和查率的差异.
主要方法:
- 通过患者门户网站将AAP指导方针改编为一个三问选器,集成到电子健康记录 (EHR) 中.
- 为没有门户访问的患者建立了基于纸质的备份工作流程.
- 利用了用于临床决策支持的不间断警报,并测量了查和随访率;分析了与查的人口相关性.
主要成果:
- 在72,037名符合条件的患者中,41,433人 (58%) 在2024年3月至2025年2月期间完成了查.
- 在3463名患者 (8.4%) 中确定了临床可行的阳性查.
- 只有31%的阳性病例下令进行后续评估;较低的查率与不活跃的门户状态,年龄较大,未知种族和公共保险有关.
结论:
- 基于病史的普遍查产生了8.4%的阳性率,这表明对心脏病学转诊的潜在需求很大.
- 查采用和遵守后续协议的情况不理想,超过一半的符合条件的患者没有接受查,少数阳性查导致评估.
- 实施突出了差异,在特定的弱势群体中观察到较低的查率.
相关概念视频
01:30Pulse rhythm
749
Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
749
01:17Assessment of apical pulse
802
Assessing the Apical Pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
802
01:30Preventive Healthcare Services
957
Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
957
01:11Pulse Assessment Sites
878
Pulse assessment sites are crucial in evaluating a patient's cardiovascular health. By assessing the pulsations of arteries at specific anatomical locations, healthcare professionals can gather valuable information about blood flow, heart rate, and peripheral circulation. Understanding these pulse assessment sites is essential for conducting comprehensive cardiovascular evaluations and monitoring patients' overall health. These sites are strategically chosen due to the accessibility and...
878