Crenshaw Molly M, Owens Caitlyn R, Dow-Smith Carrie, Olm-Shipman Casey, Monroe Rasheeda T
University of North Carolina School of Medicine, Institute for Healthcare Quality Improvement.
WakeMed Health and Hospitals Pediatric Primary Care.
Pediatr Qual Saf. 2021 Dec 15;6(6):e482. doi: 10.1097/pq9.0000000000000482. eCollection 2021 Nov-Dec.
Universal screening for adverse childhood experiences (ACEs) is recommended by the American Academy of Pediatrics due to downstream health risks. However, widespread screening practices have not been adopted.
We used quality improvement methods to establish ACEs screening in a busy pediatric clinic that serves primarily Medicaid-insured and Spanish-speaking patients. The final Plan-Do-Study-Act cycle included the screening of both the patient and his/her caregiver(s). ACEs scores were a process measure; balancing measures were the average time to screen, the number of referrals generated, and qualitative caregiver reception.
We screened 232 families, and the process maintained a ≥ 80% completion rate of ACEs screening for 1-month-old children and their caregivers during the final 10 weeks. 23% of caregivers had an ACEs score ≥ 4; overall, 6% were referred for further resources. The average time to discuss the screen was 86.78 seconds. The general caregiver reception was gratitude; 2% refused screening.
This study demonstrates the feasibility of initiating ACEs screening of 1 age group and their caregivers using quality improvement methods.
由于存在下游健康风险，美国儿科学会建议对儿童期不良经历（ACEs）进行普遍筛查。然而，广泛的筛查做法尚未得到采用。
我们运用质量改进方法，在一家繁忙的儿科诊所开展ACEs筛查，该诊所主要服务于医疗补助保险患者和讲西班牙语的患者。最终的计划-实施-研究-改进循环包括对患者及其照顾者进行筛查。ACEs评分是一项过程指标；平衡指标包括筛查的平均时间、产生的转诊数量以及照顾者的定性反馈。
我们对232个家庭进行了筛查，在最后10周内，该过程对1岁儿童及其照顾者的ACEs筛查完成率保持在≥80%。23%的照顾者ACEs评分≥4；总体而言，6%被转介以获取更多资源。讨论筛查结果的平均时间为86.78秒。照顾者总体反馈是感激；2%拒绝筛查。
本研究证明了使用质量改进方法对一个年龄组及其照顾者开展ACEs筛查的可行性。
