Stipelman Carole H, Stoddard Gregory J, Smith Elizabeth R, Bell Jamie J, Sivaloganathan Vasee, Liu Diane, Goldman-Luthy Jennifer A, Nguyen Quang-Tuyen, Rivero Andrea, Burgi Jennifer R, Young Paul C
University of Utah, Salt Lake City, UT, USA.
University of Utah Hospitals and Clinics Enterprise Data Warehouse, Salt Lake City, UT, USA.
Clin Pediatr (Phila). 2019 Dec;58(14):1528-1533. doi: 10.1177/0009922819884403. Epub 2019 Oct 22.
We performed a quality improvement intervention to increase universal lipid screening in well-child visits (age 9 to 11 years): 12-month preintervention; phase 1 (8 months) with provider education, group monthly chart review with feedback, and electronic health record cues to order lipids; and phase 2 (16 months) with electronic health record cues and examination room phlebotomy. Outcomes were compared with clinics having no intervention. In phase 1, immediate treatment effect on the regression line for provider behavior (proportion of visits with lipids ordered) showed 34% increase in intervention and 7% decrease in comparison clinics; patient behavior (phlebotomy completed) showed 19% increase in intervention and 5% decrease in comparison clinics. At the beginning of phase 2, the intervention clinic had average 44% orders entered and 33% phlebotomy completed per well-child visit, and these proportions were maintained. Provider education and chart review with feedback were associated with the greatest gains in outcomes.
我们开展了一项质量改进干预措施，以提高健康儿童（9至11岁）就诊时的血脂普遍筛查率：干预前12个月；第一阶段（8个月）进行提供者教育、每月小组病历审查并给予反馈，以及利用电子健康记录提示来开具血脂检查医嘱；第二阶段（16个月）利用电子健康记录提示并在检查室进行静脉采血。将结果与未进行干预的诊所进行比较。在第一阶段，对提供者行为（开具血脂检查医嘱的就诊比例）的回归线的即时治疗效果显示，干预组增加了34%，而对照诊所减少了7%；患者行为（完成静脉采血）显示，干预组增加了19%，对照诊所减少了5%。在第二阶段开始时，干预诊所每次健康儿童就诊的血脂检查医嘱录入平均为44%，静脉采血完成率为33%，且这些比例得以维持。提供者教育和带反馈的病历审查与结果的最大改善相关。
