Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening
Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening
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DOI：
10.1001/jamanetworkopen.2019.3403
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Patel, Mitesh S.
中科院分区：
文献类型：
--
作者：
Hsiang, Esther Y.;Mehta, Shivan J.;Patel, Mitesh S.
随着临床工作的进展，临床医生可能会落后于计划，并经历决策疲劳。然而，一天中的时间与癌症筛查率之间的关系尚不清楚。目的探讨初级保健门诊预约时间与临床医生预约和患者完成乳腺癌和结直肠癌筛查的关系。设计、环境和参与者：2014年9月1日至2016年8月31日，对宾夕法尼亚州和新泽西州33个初级保健诊所进行回顾性、质量改进研究。参与者包括符合乳腺癌或结直肠癌筛查条件的成年人。数据分析时间为2018年4月24日至2018年11月8日。研究期间每位患者第一次初级保健医生就诊时的门诊预约时间。主要结局和测量主要结局是临床医生在访视期间对筛查试验的要求。次要结果是患者在访视后1年内完成检查。结果在符合乳腺癌筛查条件的19254例患者中，平均（SD）年龄为60.2（6.9）岁；女性19 254只（100%），白人11 682只（60.7%），黑人5495只（28.5%）。筛查试验顺序率在上午8点最高，为63.7%，整个上午下降至上午11点48.7%，中午上升至56.2%，下午5点下降至47.8%(总体趋势校正优势比[OR]为0.94,95% CI为0.93-0.96
IMPORTANCE As the clinic day progresses, clinicians may fall behind schedule and experience decision fatigue. However, the association of time of day with cancer screening rates is unknown.OBJECTIVE To evaluate the association of primary care clinic appointment time with clinician ordering and patient completion of breast and colorectal cancer screening.DESIGN, SETTING, AND PARTICIPANTS Retrospective, quality improvement study of 33 primary care practices in Pennsylvania and New Jersey from September 1, 2014, to August 31, 2016. Participants included adults eligible for breast or colorectal cancer screening. Data analysis was conducted from April 24, 2018, to November 8, 2018.EXPOSURES Clinic appointment time during each patient's first primary care physician visit in the study period.MAIN OUTCOMES AND MEASURES Primary outcome was clinician ordering of the screening test during the visit. Secondary outcome was patient completion of the tests within 1 year of the visit.RESULTS Among the 19 254 patients eligible for breast cancer screening, the mean (SD) age was 60.2 (6.9) years; 19 254 (100%) were female, 11 682 (60.7%) were white, and 5495 (28.5%) were black. Screening test order rates were highest at 8 AM at 63.7%, decreased throughout the morning to 48.7% at 11 AM, increased to 56.2% at noon, and then decreased to 47.8% at 5 PM (adjusted odds ratio [ OR] for overall trend, 0.94; 95% CI, 0.93-0.96; P