Background

Early diagnosis and treatment of familial hypercholesterolemia reduces patient morbidity and mortality associated with coronary heart disease. Despite guidelines recommending screening of all pediatric patients aged 9 to 11 years, universal screening rates are reportedly low. Evaluating current screening practices provides key insights to inform and improve screening rates in the future.

Objective

The objective of the study was to assess universal cholesterol screening rates for a large cohort of pediatric patients within one healthcare system and at the individual provider and clinic levels.

Methods

A retrospective review of more than 50,000 electronic health records of children aged 9 to 11 years seen at 46 primary care clinics in a large Midwestern healthcare system between 2011 and 2016 was completed. Descriptive statistics of cholesterol screening status, lipid test results, and patient demographics were used for comparisons of factors influencing screening rates.

Results

Between 2011 and 2016, 4.0% of eligible pediatric patients were screened in the healthcare system. A majority of clinics and providers screened 4.0% or fewer of eligible patients. Six of the 333 providers (1.8%) screened >10% of eligible patients and completed a majority of the screening at the three higher screening clinics.

Conclusion

Rates of universal cholesterol screening for pediatric patients were low. Low guideline adherence may be an issue in more than one large healthcare system and state. A small number of physicians appear to be driving screening in clinics with higher screening rates. Further investigation into the motivations of these higher screening providers and the barriers faced by low-screening providers may help inform efforts to improve cholesterol screening rates.

中文翻译：

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在大型中西部基层医疗机构中，对9至11​​岁的儿童进行胆固醇筛查。

背景

家族性高胆固醇血症的早期诊断和治疗可降低与冠心病相关的患者发病率和死亡率。尽管有指南建议对9至11​​岁的所有儿科患者进行筛查，但普遍筛查率仍然较低。评估当前的筛查实践可提供关键见解，以告知并提高将来的筛查率。

目的

这项研究的目的是评估在一个医疗保健系统内以及在个体提供者和诊所水平上一大批儿科患者的通用胆固醇筛查率。

方法

在2011年至2016年之间，对中西部大型医疗保健系统的46家初级保健诊所中的50,000多名9至11岁儿童的电子健康记录进行了回顾性审查。胆固醇筛查状态，脂质测试结果和患者人口统计的描述性统计数据用于比较影响筛查率的因素。

结果

在2011年至2016年之间，在医疗保健系统中筛查了4.0％合格的儿科患者。大多数诊所和提供者对合格患者的筛查率为4.0％或更少。333家医疗服务提供者中有6家（占1.8％）对合格患者进行了10％以上的筛查，并在三所更高的筛查诊所完成了大部分筛查。

结论

儿科患者普遍的胆固醇筛查率很低。在多个大型医疗保健系统和州中，准则遵循率低可能是一个问题。少数医生似乎在筛查率较高的诊所中推动筛查。对这些较高筛查提供者的动机和低筛查提供者面临的障碍进行进一步调查，可能有助于提高胆固醇筛查率。