评估护士主导的社区超声筛查对日本髋关节发育不良的实施情况：一项混合方法的RE-AIM研究。

IF 7.1 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2026-08-01 Epub Date: 2026-05-02 DOI:10.1016/j.ijnurstu.2026.105552

Kyoko Yoshioka-Maeda , Hiroshige Matsumoto , Chikako Honda , Takeshi Kinjo , Kiyoshi Aoki , Keita Okada , Mana Shirouchi , Misa Shiomi , Noriko Hosoya , Tadashi Hattori

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引用次数: 0

摘要

背景：髋关节发育不良仍然是一种可预防但未被诊断的疾病。依靠体格检查的传统筛查策略灵敏度有限，无法实现全面的人口覆盖。尽管普遍的超声筛查显示出希望，但在现实世界的公共卫生系统中支持可扩展、可持续和护士主导的社区实施模式的证据仍然有限。目的：利用可及性、有效性、采用性、实施性和维持性框架评估日本护士主导的社区超声髋关节筛查项目纳入常规妇幼保健服务。设计：采用混合方法设计的前瞻性队列研究。背景：三个日本农村城市（2024年2月至2025年8月）。参与者：参与城市中接受新生儿常规家访或育儿咨询的公共卫生护士、助产士、婴儿及其照顾者。方法：从以下几个方面对现有妇幼保健服务进行评估：覆盖面（覆盖率）；有效性（早期转诊到医疗机构的婴儿比例和平均年龄，以及转诊后护理人员报告的结果）；采用率（护士采用率）；实施（符合Graf标准的超声图像比例、检查时间、操作难度和成本）；和维护（延续和策略集成）。超声图像被上传到一个安全的加密云服务器上，并由通过graf认证的儿科骨科医生远程解释，并在整个实施过程中向护士提供结构化的反馈。结果：349例婴幼儿共检查818次。估计覆盖率为95.6%，表明接近普遍范围。85.8%的检查获得符合Graf标准的标准平面图像。非I型髋关节占8.7%的病例，7.0%的婴儿接受进一步评估。在这些转诊婴儿中，97.6%到医疗机构就诊，54.8%需要继续随访，4.8%需要治疗。采用率高，95.5%受过培训的护士进行筛查。实施方面的挑战包括婴儿定位、数据上传错误和有限的数字集成；然而，来自骨科医生的跨专业反馈提高了技术性能。超声可视化增强了护理人员的理解，并促进了及时遵守转诊建议。各市继续进行筛查，显示维护力度强。结论：将护士主导的超声髋关节筛查纳入常规妇幼保健系统是可行的。该模型能够在没有临床症状的情况下早期识别可疑的髋关节发育不良，并从精确的公共卫生护理角度为资源有限的环境提供公平的方法。注册：大学医院医学信息网临床试验注册；UMIN000051929 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000059248)。报名日期：2023年9月16日。招聘开始：2023年11月1日。摘要：护士主导的社区超声髋关节筛查覆盖率达到95.6%，8.7%的筛查婴儿疑似脱位或髋关节发育不良。

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Evaluating implementation of nurse-led community-based ultrasound screening for developmental dysplasia of the hip in Japan: A mixed-methods RE-AIM study

Background

Developmental dysplasia of the hip remains a preventable yet underdiagnosed condition. Conventional screening strategies that rely on physical examination demonstrate limited sensitivity and fail to achieve comprehensive population coverage. Although universal ultrasound screening has shown promise, evidence supporting scalable, sustainable, and nurse-led community-based implementation models within real-world public health systems remains limited.

Objective

To evaluate a nurse-led community-based ultrasound hip screening program integrated into routine maternal and child health services in Japan using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.

Design

A prospective cohort study with a mixed-methods design.

Settings

Three rural Japanese municipalities (February 2024 to August 2025).

Participants

Public health nurses, midwives, infants, and their caregivers who underwent routine newborn home visits or child-rearing consultations in the participating municipalities.

Methods

The existing maternal and child health services evaluated across the following dimensions: Reach (coverage rate); Effectiveness (the proportion and mean age of infants referred early to medical institutions, and caregiver-reported outcomes following referral); Adoption (nurse adoption rate); Implementation (the proportion of ultrasound images meeting Graf's criteria, examination time, operational challenges, and cost); and Maintenance (continuation and policy integration). Ultrasound images were uploaded to a secure encrypted cloud server and interpreted remotely by Graf-certified pediatric orthopedic surgeons, with structured feedback provided to nurses throughout the implementation process.

Results

A total of 818 examinations were performed in 349 infants. The estimated coverage rate was 95.6%, indicating a near-universal range. Standard-plane images meeting Graf's criteria were obtained in 85.8% of examinations. Non-Type I hips accounted for 8.7% of cases, and 7.0% of infants were referred for further evaluation. Of these referred infants, 97.6% visited medical institutions, 54.8% required continued follow-up, and 4.8% required treatment. Adoption was high, with 95.5% of trained nurses conducting screenings. Implementation challenges included infant positioning, data-upload errors, and limited digital integration; however, interprofessional feedback from orthopedic surgeons improved technical performance. Ultrasound visualization enhanced caregiver understanding and facilitated timely adherence to referral recommendations. All municipalities continued screening, demonstrating strong maintenance.

Conclusions

Nurse-led ultrasound hip screening can be feasibly integrated into routine maternal and child healthcare systems. This model enables early identification of suspected developmental dysplasia of the hip without clinical signs, and offers an equitable approach in resource-limited settings from a precision public health nursing perspective.

Registration

University Hospital Medical Information Network Clinical Trial Registry; UMIN000051929 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000059248).

Registration date: September 16, 2023. Start of recruitment: November 01, 2023.

Social media abstract

Nurse-led community ultrasound hip screening achieved 95.6% coverage, and 8.7% of the screened infants had a suspected dislocation or hip dysplasia.

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).