指导原则多于州：美国铅筛查和管理指南的差异及其对可共享 CDS 开发的影响。

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development.

机构信息

Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA.

Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19146, USA.

出版信息

BMC Public Health. 2020 Jan 29;20(1):127. doi: 10.1186/s12889-020-8225-8.

DOI:10.1186/s12889-020-8225-8

PMID:31996264

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6990572/

Abstract

BACKGROUND

Pediatric lead exposure in the United States (U.S.) remains a preventable public health crisis. Shareable electronic clinical decision support (CDS) could improve lead screening and management. However, discrepancies between federal, state and local recommendations could present significant challenges for implementation.

METHODS

We identified publically available guidance on lead screening and management. We extracted definitions for elevated lead and recommendations for screening, follow-up, reporting, and management. We compared thresholds and level of obligation for management actions. Finally, we assessed the feasibility of development of shareable CDS.

RESULTS

We identified 54 guidance sources. States offered different definitions of elevated lead, and recommendations for screening, reporting, follow-up and management. Only 37 of 48 states providing guidance used the Center for Disease Control (CDC) definition for elevated lead. There were 17 distinct management actions. Guidance sources indicated an average of 5.5 management actions, but offered different criteria and levels of obligation for these actions. Despite differences, the recommendations were well-structured, actionable, and encodable, indicating shareable CDS is feasible.

CONCLUSION

Current variability across guidance poses challenges for clinicians. Developing shareable CDS is feasible and could improve pediatric lead screening and management. Shareable CDS would need to account for local variability in guidance.

摘要

背景

美国（U.S.）儿童铅暴露仍然是一个可预防的公共卫生危机。可共享的电子临床决策支持（CDS）可以改善铅筛查和管理。然而，联邦、州和地方建议之间的差异可能会对实施带来重大挑战。

方法

我们确定了公共铅筛查和管理指南。我们提取了升高的铅定义以及筛查、随访、报告和管理建议。我们比较了管理措施的阈值和义务水平。最后，我们评估了可共享 CDS 的开发可行性。

结果

我们确定了 54 个指导来源。各州提供了不同的升高铅定义，以及筛查、报告、随访和管理建议。只有 48 个提供指导的州中的 37 个使用了疾病控制与预防中心（CDC）的升高铅定义。有 17 种不同的管理措施。指导来源平均指出了 5.5 项管理措施，但对这些措施的标准和义务水平有所不同。尽管存在差异，但这些建议结构合理、可操作且可编码，表明可共享 CDS 是可行的。