Center for Perinatal Research and
Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Pediatrics. 2020 May;145(5). doi: 10.1542/peds.2019-2126. Epub 2020 Apr 8.
Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines.
The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3- to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function.
The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with = .008; 3- to 4-month visits per site increased from the median (interquartile range) 14 (5.2-73.7) to 54 (34.5-152.0), with < .001; and no-show rates were not different. Parent questionnaires revealed positive provider perception with improvement opportunities for information content and understandability.
Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.
在可塑性最大的时期，早期诊断脑瘫（CP）对于获得基于证据的干预至关重要。2017 年，国际 CP 早期检测指南在对证据进行系统回顾的基础上发布。我们的研究目的是通过在 5 个不同的美国高危婴儿随访项目网络中一致实施这些指南，降低 CP 的诊断年龄。
本研究利用计划-执行-研究-行动和精益方法。主要结果是 CP 的诊断年龄。在相应的 9 个月基线期间和整个研究的每季度获取数据。平衡措施是诊所未出现率和父母对诊断就诊的看法。诊所团队进行了优势、劣势、机会和威胁分析、流程评估、标准化评估培训和家长问卷调查。3-4 个月的诊所就诊是一个关键的流程步骤，因为它包括哈默史密斯婴儿神经检查、一般运动评估和运动功能的标准化评估。
CP 的诊断年龄从加权平均值 19.5（95%置信区间 16.2 至 22.8）下降至 9.5 个月（95%置信区间 4.5 至 14.6）， =.008；每个地点的 3-4 个月就诊次数从中位数（四分位距）14（5.2-73.7）增加到 54（34.5-152.0）， <.001；未出现率没有差异。家长问卷显示，提供者的看法积极，认为信息内容和可理解性存在改进机会。
在不同的高危婴儿随访诊所中，大规模实施 CP 早期检测的国际指南是可行的。该倡议受到了家庭的积极响应，且没有对诊所运营流程产生不利影响。还需要额外的家长支持和教育。
