Impact of a generalizable reminder system on colorectal cancer screening in diverse primary care practices: a report from the prompting and reminding at encounters for prevention project.
Impact of a generalizable reminder system on colorectal cancer screening in diverse primary care practices: a report from the prompting and reminding at encounters for prevention project.
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DOI：
10.1097/mlr.0b013e31817c60d7
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发表时间：
2008-09
期刊：
影响因子：
3
通讯作者：
Underwood JM
中科院分区：
文献类型：
--
作者：
Nease DE Jr;Ruffin MT 4th;Klinkman MS;Jimbo M;Braun TM;Underwood JM
计算机提醒系统（CRS）显示出增加预防服务的希望，如结直肠癌（CRC）筛查。然而，以前的研究还没有评估一个普遍的CRS在不同的，社区初级保健的做法。我们评估了一种可推广的CRS，ClinfoTracker，是否可以提高不同初级保健实践中CRC的筛查率。该研究是一项前瞻性试验，使用历史对照数据在12个五大湖研究实践网络社区为基础的，初级保健的做法，分布从东南部到上半岛密歇根州。我们的结果指标是在9个月的研究期间观察到的患者的研究前和研究后实践水平的CRC筛查率。维持CRS的能力通过提醒打印的天数来衡量。使用了实地说明来审查每项业务的凝聚力和技术能力。除一种做法外，所有做法都提高了他们的CRC筛查率，从3.3%到16.8%不等。调整了实践内相关性的t检验显示，所有12个实践的筛查率从41.7%提高到50.9%，P = 0.002。技术能力影响打印天数（高技术为74%，低技术为45%，P = 0.01），凝聚力表现出对筛选的影响趋势（高凝聚力为15.3%，低凝聚力为7.9%）。在不同的初级保健实践中实施可推广的CRS，显著提高了CRC筛查率。技术能力在维持系统方面很重要，但实践凝聚力可能对筛查率有更大的影响。这项工作对实施提醒系统的做法具有重要意义。
Computerized reminder systems (CRS) show promise for increasing preventive services such as colorectal cancer (CRC) screening. However, prior research has not evaluated a generalizable CRS across diverse, community primary care practices. We evaluated whether a generalizable CRS, ClinfoTracker, could improve screening rates for CRC in diverse primary care practices. The study was a prospective trial to evaluate ClinfoTracker using historical control data in 12 Great Lakes Research In Practice Network community-based, primary care practices distributed from Southeast to Upper Peninsula Michigan. Our outcome measures were pre- and post-study practice-level CRC screening rates among patients seen during the 9-month study period. Ability to maintain the CRS was measured by days of reminder printing. Field notes were used to examine each practice’s cohesion and technology capabilities. All but one practice increased their CRC screening rates, ranging from 3.3% to 16.8% improvement. t tests adjusted for within practice correlation showed improvement in screening rates across all 12 practices, from 41.7% to 50.9%, P = 0.002. Technology capabilities impacted printing days (74% for high technology vs. 45% for low technology practices, P = 0.01), and cohesion demonstrated an impact trend for screening (15.3% rate change for high cohesion vs. 7.9% for low cohesion practices). Implementing a generalizable CRS in diverse primary care practices yielded significant improvements in CRC screening rates. Technology capabilities are important in maintaining the system, but practice cohesion may have a greater influence on screening rates. This work has important implications for practices implementing reminder systems.