Improving preventive care by prompting physicians
Improving preventive care by prompting physicians
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DOI：
10.1001/archinte.160.3.301
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发表时间：
2000-02-14
影响因子：
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通讯作者：
Brown, GD
中科院分区：
文献类型：
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作者：
Balas, EA;Weingarten, S;Brown, GD
目的：评估提示医生对健康保障的影响，回答有关提供方式的问题，确定这种信息干预的机会和局限性。方法：对1966年1月1日至1996年12月31日的临床试验报告进行系统的电子检索和人工检索。采用三个合格标准：(1)随机对照临床试验，(2)研究组中临床医生的提示、提醒或提醒，而对照组中没有类似的干预，以及(3)干预对预防护理程序频率的影响。数据由独立的评价者使用标准化的摘要表格进行摘要，并对方法的质量进行评分。使用随机效应方法进行了一系列关于触发临床行动的荟萃分析。统计分析包括33项符合条件的研究，涉及1547名临床医生和54693名患者。结果：总体而言，提示可以显著提高预防保健绩效13.1%(95%可信区间[CI]，10.5%-15.6%)。巴氏涂片的有效率为5.8%(95%可信区间，1.5%~10.1%)，流感疫苗接种的有效率为18.3%(95%可信区间，11.6%~25.1%)。干预效果不是累积性的，干预时间长短与效果大小无相关性(R=-0.015，P=0.47)。学历、住院医师比例、接生技术对催促的临床效果无显著影响。结论：通过对医生的催促，可以实现预防保健绩效的可靠提升。大力应用这一简单而有效的信息干预措施，每年可以挽救数千人的生命。卫生保健组织可以有效地使用提示、警报或提醒，以便在做出病人护理决策时向临床医生提供信息。
Objectives: To assess the impact of prompting physicians on health maintenance, answer questions regarding the mode of delivery, and identify opportunities and limitations of this information intervention.Methods: Systematic electronic and manual searches (January 1, 1966, to December 31, 1996) were conducted to identify clinical trial reports on prompting clinicians. Three eligibility criteria were applied: (1) randomized controlled clinical trial, (2) clinician prompt, alert, or reminder in the study group and no similar intervention in the control group, and (3) measurement of the intervention effect on the frequency of preventive care procedures. Data were abstracted by independent reviewers using a standardized abstraction form, and quality of methodology was scored. A series of meta-analyses on triggering clinical actions was performed using the random-effects method. The statistical analyses included 33 eligible studies, which involved 1547 clinicians and 54 693 patients.Results: Overall, prompting can significantly increase preventive care performance by 13.1% (95% confidence interval [CI], 10.5%-15.6%). However, the effect ranges from 5.8% (95% CI, 1.5%-10.1%) for Papanicolaou smear to 18.3% (95% CI, 11.6%-25.1%) for influenza vaccination. The effect is not cumulative, and the length of intervention period did not show correlation with effect size (R = -0.015, P = .47). Academic affiliation, ratio of residents, and technique of delivery did not have a significant impact on the clinical effect of prompting.Conclusions: Dependable performance improvement in preventive care can be accomplished through prompting physicians. Vigorous application of this simple and effective information intervention could save thousands of lives annually. Health care organizations could effectively use prompts, alerts, or reminders to provide information to clinicians when patient care decisions are made.