Anzeljc Samantha, Ziemnik Lisa, Koscher Stephanie, Klein Wendy, Bridge Christine, Van Horn Allyson
Ohio Chapter, American Academy of Pediatrics, Columbus, Ohio, USA.
Wilmington Medical Associates, Wilmington, Ohio, USA.
Pediatr Qual Saf. 2019 Nov 28;4(6):e241. doi: 10.1097/pq9.0000000000000241. eCollection 2019 Nov-Dec.
Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment.
Thirty-nine Ohio primary care providers interested in preschool vision screening self-selected to participate in an Institute for Healthcare Improvement Breakthrough Series learning collaborative that spanned 18 months. Charts of patients attending 3-, 4-, and 5-year well-child visits were randomly selected and reviewed for documentation of vision screening attempts, referrals, and need for rescreening.
Practitioners improved evidenced-based screening attempts for distance visual acuity and stereopsis of 3-5-year-old patients from 18% at baseline to 87% ( < 0.001) at 6 months; improved screening rates were sustained through completion of the collaborative. Baseline referral rates (26%) of abnormal vision screens improved by 59% ( < 0.001) during the first 6 months and were maintained through month 18. Rates for children with incomplete screens that were scheduled for a repeated screening increased during the first 6 months. However, changes in this metric did not reach statistical significance ( = 0.265), nor did it change during the remainder of the collaborative.
Rapid integration and maintenance of preschool vision screening guidelines are feasible across primary care settings utilizing a structured learning collaborative. Challenges with the rescreening processes for children with incomplete vision screens remain, with the 3-year age group having the greatest room for improvement.
初级保健中的学龄前视力筛查率不理想且标准化程度低。本项目的目的是通过一个学习协作环境来评估儿科初级保健对学龄前视力筛查指南的遵循情况及改进情况。
39名对学龄前视力筛查感兴趣的俄亥俄州初级保健提供者自行选择参加了一个为期18个月的医疗保健改进研究所突破性系列学习协作项目。随机选择3岁、4岁和5岁儿童健康检查就诊患者的病历，审查其中视力筛查尝试、转诊及再次筛查需求的记录。
从业者对3至5岁患者进行基于证据的远距离视力和立体视觉筛查尝试从基线时的18%提高到6个月时的87%（P<0.001）；改进后的筛查率在协作项目结束时得以维持。视力筛查异常的基线转诊率（26%）在最初6个月提高了59%（P<0.001），并维持到第18个月。计划进行重复筛查的未完成筛查儿童的比例在最初6个月有所增加。然而，这一指标的变化未达到统计学显著性（P = 0.265），在协作项目的其余时间也未改变。
利用结构化学习协作，在初级保健机构中快速整合和维持学龄前视力筛查指南是可行的。视力筛查未完成儿童的再次筛查过程仍存在挑战，3岁年龄组的改进空间最大。
