缩小慢性病检测的差距:在安全网人口中评估家庭向测试
Megan Schultz1, Katelyn Laue1, Nicole Bryer2
1National Kidney Foundation, New York, NY, USA.
Journal of primary care & community health
|July 28, 2025
概括
在家用尿中的白蛋白-肌酸比 (uACR) 测试增加了在服务不足的人群中早期发现慢性病 (CKD). 该研究强调需要在安全网设置中改进CKD查.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 慢性病 (CKD) 影响了美国7个成年人中的1人,90%的人不知道,20%的风险人群接受了测试.
- 安全网设置不成比例地为患有风险因素和护理障碍的CKD患者提供服务.
- 国家脏基金会与FQHC合作,在高风险人群中加强CKD测试.
研究的目的:
- 为了评估在家用尿中的白蛋白-肌酸比 (uACR) 测试方法.
- 在安全网设置中增加指南推的CKD测试.
- 为了识别患有CKD进展高风险的个体.
主要方法:
- 电子健康记录 (EHR) 分析确定了符合条件的患者在家用uACR测试套件.
- 套件通过智能手机应用程序提供了即时的结果,并将数据路由到临床的电子健康记录.
- 该倡议使用在美国密苏里州 (2023) 的RE-AIM框架进行了评估.
主要成果:
- 32%的符合条件的患者 (1496/4677) 完成了uACR测试;50%的患者表现为白尿.
- 84%的白尿患者进行了随访,32%完成了指导方针推的随访测试.
- 专发症在各个年龄组中普遍存在,特别是在黑人患者 (P<.0001) 中,通常是eGFR≥60mL/min/1.73m2.
结论:
- 对于早期CKD诊断,特别是安全网设置中,需要紧急改进uACR测试.
- 家庭测试改善了服务不足的社区获得护理的机会,为CKD风险识别提供了可复制的模型.
- 简化计划协调和实施质量改进活动可以进一步加强后续测试,缩小CKD护理差距.
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