Mann Elizabeth A, Alexander Kelsi, Beaton Whitney, Roe Elizabeth B, Grant Amy, Shadman Kristin A
From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
UW Health Kids, Madison, Wisc.
Pediatr Qual Saf. 2024 May 27;9(3):e734. doi: 10.1097/pq9.0000000000000734. eCollection 2024 May-Jun.
Screening for early detection of microalbuminuria signaling kidney disease should begin as early as the time of diagnosis of youth-onset type 2 diabetes. This quality improvement initiative aimed to standardize urine nephropathy screening in pediatric patients with type 2 diabetes at a tertiary academic medical center and increase a baseline screening rate of 56%-75% over 6 months (September 2022-February 2023) and sustain that increase for 6 months (March through August 2023).
A multi-disciplinary team used quality improvement methods and iterative Plan-Do-Study-Act cycles. Targeted interventions included previsit planning workflow, education, and a new-onset triage protocol. The team collected data at baseline and prospectively by reviewing electronic medical records. The primary outcome measure was pediatric type 2 diabetes clinic visits in diabetes clinic with urine nephropathy screening before or on the visit date.
A total of 121 youth were scheduled for T2D clinic visits between September 2021 and August 2023. The mean age was 14.5 years, and 60% were women, 40% were non-Hispanic Black, 28% were Hispanic/Latino, and 15% reported Spanish as their preferred language. Following the interventions of this project, urine nephropathy screening increased from 56% to 75%, and this change was sustained for 6 months.
Interventions focused on efficient recognition of the population needing screening, coordinated internal processes around screening, a shared understanding between all stakeholders, and practical support in the healthcare system increased urine nephropathy screening with sustained improvement.
为早期发现提示肾病的微量白蛋白尿而进行的筛查应在青年期2型糖尿病诊断时尽早开始。这项质量改进计划旨在规范三级学术医疗中心2型糖尿病儿科患者的尿肾病筛查，并在6个月内（2022年9月至2023年2月）将56% - 75%的基线筛查率提高，并在接下来的6个月内（2023年3月至8月）维持这一增长。
一个多学科团队采用质量改进方法和迭代的计划 - 实施 - 研究 - 改进循环。有针对性的干预措施包括就诊前规划工作流程、教育和新发患者分诊方案。该团队通过审查电子病历在基线时和前瞻性地收集数据。主要结局指标是糖尿病门诊中在就诊日期或之前进行尿肾病筛查的2型糖尿病儿科门诊就诊情况。
2021年9月至2023年8月期间，共有121名青少年计划进行2型糖尿病门诊就诊。平均年龄为14.5岁，60%为女性，40%为非西班牙裔黑人，28%为西班牙裔/拉丁裔，15%表示首选语言为西班牙语。在该项目的干预措施实施后，尿肾病筛查率从56%提高到75%，且这一变化持续了6个月。
聚焦于有效识别需要筛查的人群、围绕筛查协调内部流程、所有利益相关者之间达成共识以及医疗系统提供实际支持的干预措施提高了尿肾病筛查率，并持续改善。
