Crosby Lori E, Joffe Naomi E, Davis Blair, Quinn Charles T, Shook Lisa, Morgan Darice, Simmons Kenya, Kalinyak Karen A
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; College of Medicine, University of Cincinnati, Cincinnati, Ohio.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; College of Medicine, University of Cincinnati, Cincinnati, Ohio.
Am J Prev Med. 2016 Jul;51(1 Suppl 1):S10-6. doi: 10.1016/j.amepre.2016.01.021.
Stroke, a devastating complication of sickle cell anemia (SCA), can cause irreversible brain injury with physical and cognitive deficits. Transcranial Doppler ultrasonography (TCD) is a non-invasive tool for identifying children with SCA at highest risk of stroke. National guidelines recommend that TCD screening begin at age 2 years, yet there is research to suggest less than half of young children undergo screening. The purpose of this project was to use quality improvement methods to improve the proportion of patients aged 24-27 months who successfully completed their initial TCD from 25% to 75% by December 31, 2013. Quality improvement methods (e.g., process mapping, simplified failure mode effect analysis, and plan-do-study-act cycles) were used to develop and test processes for identifying eligible patients, scheduling TCDs, preparing children and families for the first TCD, and monitoring outcomes (i.e., TCD protocol). Progress was tracked using a report of eligible patients and a chart showing the age in months for the first successful TCD (population metric). As of December 2013, 100% of eligible patients successfully completed their initial TCD screen; this improvement was maintained for the next 20 months. In November 2014, a Welch's one-way ANOVA was conducted. Results showed a statistically significant difference between the average age of first TCD for eligible patients born in 2009 and eligible patients born during the intervention period (2010-2013; F[1,11.712]=16.03, p=0.002). Use of quality improvement methods to implement a TCD protocol was associated with improved TCD screening rates in young children with SCA.
中风是镰状细胞贫血（SCA）的一种毁灭性并发症，可导致伴有身体和认知缺陷的不可逆脑损伤。经颅多普勒超声检查（TCD）是一种用于识别中风风险最高的SCA儿童的非侵入性工具。国家指南建议TCD筛查在2岁时开始，但有研究表明，接受筛查的幼儿不到一半。本项目的目的是运用质量改进方法，到2013年12月31日将24至27个月大的患者成功完成首次TCD检查的比例从25%提高到75%。采用质量改进方法（如流程映射、简化失效模式效应分析和计划-执行-研究-行动循环）来制定和测试识别符合条件患者、安排TCD检查、让儿童及其家庭为首次TCD检查做好准备以及监测结果（即TCD方案）的流程。使用符合条件患者报告和显示首次成功TCD检查月龄的图表（总体指标）来跟踪进展情况。截至2013年12月，100%的符合条件患者成功完成了首次TCD筛查；这一改善在接下来的20个月里得以维持。2014年11月，进行了韦尔奇单向方差分析。结果显示，2009年出生的符合条件患者与干预期间（2010 - 2013年）出生的符合条件患者首次TCD检查的平均年龄存在统计学显著差异（F[1,11.712]=16.03，p = 0.002）。运用质量改进方法实施TCD方案与提高SCA幼儿的TCD筛查率相关。
