School of Medicine (N Bismar), University of Texas Southwestern (UTSW), Dallas, Tex.
Division of Pediatric Gastroenterology, Department of Pediatrics (SE Barlow, CB Turer), University of Texas Southwestern (UTSW), Dallas, Tex; Department of Population Health and Data Science (SE Barlow, CB Turner), UTSW Medical Center, Dallas, Tex; Children's Health (SE Barlow, CB Turer), Dallas, Tex.
Acad Pediatr. 2020 Aug;20(6):776-783. doi: 10.1016/j.acap.2019.11.012. Epub 2019 Nov 26.
Despite recognition that hypertension is associated with childhood obesity, data suggest that high blood pressure (BP) is infrequently diagnosed in children. This study sought to examine provider communication with overweight school-age children regarding BP measurements that were high at well-child visits.
Cross-sectional mixed-methods analysis of audio-recorded communication from well-child visits with overweight 6-12-year-olds. Data from the subset of children with elevated BPs were used for this study. Three BP measures obtained at the audio-recorded visit were averaged, paired with historical BPs stored in the health record, and compared to contemporary/Fourth-Report thresholds to determine if children had elevated/hypertensive BPs only at the audio-recorded visit or met hypertension-diagnostic criteria (hypertension-level BP ≥3 separate visits). Two reviewers used visit transcripts to categorize communication about BP as "absent," "unclear," or "direct." Provider use of a billing diagnosis for elevated BP/hypertension in visits with direct-BP-communication was explored.
In 36 of 126 (29%) visit-audio-recordings, children had elevated/hypertensive BPs. Thirty-three of the 36 eligible (92%) had intelligible audio-recordings. Of these, 9 (25%) were overweight and 24 (75%) had obesity. Seventeen (52%) had elevated BPs, and 16 (48%) hypertensive BPs. Ten (30%) met criteria for hypertension diagnosis. BP communication was absent in 20 visits (61%), unclear in 8 (24%), and direct in 5 visits (15%). Billing diagnoses for elevated BP/hypertension were entered at 4 of 5 (80%) visits with direct-BP communication.
Most overweight children with elevated BPs did not receive communication that BP is high at well-child visits. Relevant billing diagnoses may indicate direct-BP communication.
尽管人们认识到高血压与儿童肥胖有关，但数据表明，儿童高血压（BP）的诊断率较低。本研究旨在研究超重学龄儿童在常规儿童保健就诊时血压升高时，医务人员与他们的沟通情况。
对超重 6-12 岁儿童常规儿童保健就诊时的音频记录进行横断面混合方法分析。本研究使用了该部分儿童中血压升高的儿童的数据。将在音频记录就诊时获得的三个血压测量值进行平均，与健康记录中存储的历史血压值进行配对，并与当代/第四次报告标准进行比较，以确定儿童仅在音频记录就诊时是否存在血压升高/高血压或是否符合高血压诊断标准（高血压水平的血压≥3 次单独就诊）。两位审阅者使用就诊记录来将有关血压的沟通归类为“缺失”、“不明确”或“直接”。在有直接血压沟通的就诊中，探讨了医务人员使用计费诊断来诊断血压升高/高血压的情况。
在 126 次就诊音频记录中的 36 次中，儿童的血压升高/高血压。在 36 次符合条件的音频记录中有 33 次（92%）可以理解。其中，9 名（25%）超重，24 名（75%）肥胖。17 名（52%）有血压升高，16 名（48%）有高血压。10 名（30%）符合高血压诊断标准。20 次就诊（61%）没有血压沟通，8 次就诊（24%）不明确，5 次就诊（15%）直接沟通。在有直接血压沟通的 5 次就诊中有 4 次（80%）输入了升高的血压/高血压的计费诊断。
大多数血压升高的超重儿童在常规儿童保健就诊时未收到血压升高的相关信息。相关计费诊断可能表明进行了直接的血压沟通。
