Williamson Ariel A, Powell Maura, Luberti Anthony, Lawton Gregory, Min Jungwon, Dudley Jesse, Wu Joe, Makeneni Spandana, DiFiore Gabrielle, Nekrasova Ekaterina, Kelly Mary Kate, Rapposelli Angela, Massey James, Uwah Eberechukwu A, Tapia Ignacio E, Fiks Alexander G
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
University of Pennsylvania, Perelman School of Medicine, Philadelphia.
JAMA Netw Open. 2025 Aug 1;8(8):e2525346. doi: 10.1001/jamanetworkopen.2025.25346.
Sleep is crucial for healthy growth, academic success, executive functioning, and mental health. However, sleep is not consistently and rigorously addressed in pediatric primary care.
To describe the development and reach, adoption, implementation, effectiveness, and maintenance of a well-child visit, electronic sleep screener with educational resources in a large primary care network.
DESIGN, SETTING, AND PARTICIPANTS: In this case-control study of primary care practices in Pennsylvania and New Jersey, retrospective, observational electronic health records and implementation data were drawn for preimplementation (November 1, 2018, to September 30, 2019), phased-scaling (October 1, 2019, to June 30, 2021), implementation (July 1, 2021, to June 30, 2022), and maintenance (July 1, 2022, to June 30, 2023) periods. Multivariate logistic regression examined the effectiveness by comparing implementation vs preimplementation rates of sleep disorder diagnosis, polysomnogram orders, and sleep-related referrals. Patients were seen for a well-child visit during the preimplementation and implementation periods, without exclusions. Data were analyzed from October 10, 2023, to May 2, 2025.
An age-based, electronic sleep screener assessing infant bed sharing, frequent snoring (≥3 nights/week), perceived sleep problems, insufficient sleep duration, and adolescent daytime sleepiness.
The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework guided the outcomes including sleep screener use, results, and primary care clinician (PCC)-rendered sleep disorder diagnosis, polysomnogram orders, and sleep-related referrals at the well-child visit.
A total of 409 217 well-child visits for 288 307 unique patients aged 18 years or younger (51.2% male; 49.9% White non-Hispanic or Latine) were included in the preimplementation and implementation periods. During implementation, 204 872 unique patients in 31 practices completed the screener, with adoption in 89.5% of all well-child visits. Overall, 9.7% of patients endorsed frequent snoring, 12.2% sleep problems, and 34.4% insufficient sleep. Infant bed sharing was endorsed in 6.5% of infants, whereas 14.7% of adolescents endorsed daytime sleepiness. Compared with the preimplementation period, at well-child visits with a completed sleep screener, PCCs were significantly more likely to render a sleep disorder diagnosis (odds ratio, 1.64 [95% CI, 1.56-1.73]), order a polysomnogram (odds ratio, 2.67 [95% CI, 2.32-3.20]), and refer to sleep (odds ratio, 6.48 [95% CI, 5.03-8.34]) or otolaryngology (odds ratio, 4.46 [95% CI, 3.95-5.02]) clinics. Minimal adaptations occurred during implementation, and adoption was high and persistent (92.5% of well-child visits) during the maintenance period.
In this case-control study, a brief, electronic well-child visit sleep screener was widely adopted and maintained in a sociodemographically diverse primary care network and was associated with increased recognition and management of sleep problems.
睡眠对于健康成长、学业成功、执行功能和心理健康至关重要。然而，儿科初级保健中对睡眠问题并未始终如一地进行严格处理。
描述在一个大型初级保健网络中，一项包含教育资源的儿童健康检查电子睡眠筛查工具的开发、推广、采用、实施、有效性及维持情况。
设计、背景和参与者：在这项针对宾夕法尼亚州和新泽西州初级保健实践的病例对照研究中，收集了2018年11月1日至2019年9月30日（实施前）、2019年10月1日至2021年6月30日（分阶段推广）、2021年7月1日至2022年6月30日（实施）以及2022年7月1日至2023年6月30日（维持）期间的回顾性观察电子健康记录和实施数据。多变量逻辑回归通过比较睡眠障碍诊断、多导睡眠图检查单开具以及与睡眠相关转诊的实施阶段与实施前阶段的比率来检验有效性。在实施前和实施期间接受儿童健康检查的患者均纳入研究，无排除标准。数据于2023年10月10日至2025年5月2日进行分析。
一种基于年龄的电子睡眠筛查工具，评估婴儿同床睡眠、频繁打鼾（每周≥3晚）、感知到的睡眠问题、睡眠时间不足以及青少年日间嗜睡情况。
推广、有效性、采用、实施和维持框架指导了相关结局，包括睡眠筛查工具的使用、结果，以及初级保健医生（PCC）在儿童健康检查时做出的睡眠障碍诊断、开具的多导睡眠图检查单以及与睡眠相关的转诊。
在实施前和实施期间，共纳入了针对288307名18岁及以下独特患者的409217次儿童健康检查（51.2%为男性；49.9%为非西班牙裔或拉丁裔白人）。在实施期间，31家诊所的204872名独特患者完成了筛查，在所有儿童健康检查中的采用率为89.5%。总体而言，9.7%的患者认可频繁打鼾，(12.2%)的患者认可存在睡眠问题，(34.4%)的患者认可睡眠时间不足。6.5%的婴儿认可同床睡眠情况，而14.7%的青少年认可日间嗜睡情况。与实施前阶段相比，在完成睡眠筛查的儿童健康检查中，PCC做出睡眠障碍诊断的可能性显著更高（优势比，1.64 [95%可信区间，1.56 - 1.73]），开具多导睡眠图检查单的可能性显著更高（优势比，2.67 [95%可信区间，2.32 - 3.20]），以及转诊至睡眠（优势比，6.48 [95%可信区间，5.03 - 8.34]）或耳鼻喉科（优势比，4.46 [95%可信区间，3.95 - 5.02]）诊所的可能性显著更高。实施过程中调整极少，在维持期间采用率高且持续（儿童健康检查的92.5%）。
在这项病例对照研究中，一种简短的儿童健康检查电子睡眠筛查工具在一个社会人口统计学特征多样的初级保健网络中得到广泛采用和维持，并与睡眠问题的识别和管理增加相关。
