Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington.
American Academy of Pediatrics, Itasca, Illinois.
Pediatrics. 2024 Aug 1;154(2). doi: 10.1542/peds.2023-065552.
The American Academy of Pediatrics recommends screening during the first 3 years of life for developmental risk/delay, maternal depression, and social determinants of health (SDOH) using standardized tools. Adoption of these guidelines has been gradual, and barriers to screening are as varied as pediatric practices are themselves.
We analyzed 2019 American Academy of Pediatrics Periodic Survey data. The survey included pediatricians' screening practices for developmental delay, maternal depression, and SDOH, and barriers to screening. We used Cochran's Q and McNemar's tests to compare barriers across topics, and χ2 tests and multivariable logistic regression to examine the relationship between barriers and screening practices.
The survey response rate was 46.9% (n = 688). Most pediatricians reported screening/surveilling for developmental delay (98.1%), maternal depression (83.2%), and SDOH (76.7%), but fewer used standardized instruments to do so (59.0%, 44.9%, 12.6%, respectively). Those not screening/only surveilling for maternal depression were more likely to report that screening is not an appropriate role for the pediatrician and difficulty prioritizing time. For SDOH, those not screening/only surveilling were more likely to report instruments not available in the electronic health record, lack of knowledge regarding referral options, and lack of treatment options for positive screens.
Rates of standardized screening, and barriers pediatricians encounter, have important implications for improving quality of early childhood preventive care. Opportunities include expanding the primary care team and integrating screening tools into the electronic health record. Programs to support social needs and maternal mental health could be strengthened to ensure robust referral options are available.
美国儿科学会建议在生命的头 3 年使用标准化工具筛查发育风险/延迟、产妇抑郁和健康的社会决定因素（SDOH）。这些指南的采用是渐进的，筛查障碍与儿科实践本身一样多种多样。
我们分析了 2019 年美国儿科学会定期调查数据。该调查包括儿科医生对发育迟缓、产妇抑郁和 SDOH 的筛查实践以及筛查障碍。我们使用 Cochran's Q 和 McNemar's 检验比较不同主题的障碍，使用 χ2 检验和多变量逻辑回归检验筛查障碍与筛查实践之间的关系。
调查的回复率为 46.9%（n=688）。大多数儿科医生报告筛查/监测发育迟缓（98.1%）、产妇抑郁（83.2%）和 SDOH（76.7%），但使用标准化工具进行筛查的比例较低（分别为 59.0%、44.9%和 12.6%）。那些不进行筛查/仅进行监测产妇抑郁的人更有可能报告筛查不是儿科医生的适当角色，并且难以优先安排时间。对于 SDOH，那些不进行筛查/仅进行监测的人更有可能报告电子健康记录中没有可用的工具，缺乏关于转诊选择的知识，以及对阳性筛查缺乏治疗选择。
标准化筛查的比率和儿科医生遇到的障碍对改善儿童早期预防保健质量具有重要意义。机会包括扩大初级保健团队并将筛查工具整合到电子健康记录中。可以加强支持社会需求和产妇心理健康的计划，以确保提供强大的转诊选择。
