Cancer early-detection services in community health centers for the underserved - A randomized controlled trial
Cancer early-detection services in community health centers for the underserved - A randomized controlled trial
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DOI：
10.1001/archfami.7.4.320
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发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Tosteson, TD
中科院分区：
文献类型：
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作者：
Dietrich, AJ;Tobin, JN;Tosteson, TD
背景资料：实现癌症早期检测的目标仍然是一个挑战，特别是在低收入和少数民族population.Design/Setting：一项随机试验的基础上，在62个社区卫生中心的不足，在纽约，新泽西，康涅狄格州西部。家庭医生在大多数中心的工作人员。干预：讲习班，材料，并为中心领导人不断建议促进实施预防服务办公室系统，以确定需要服务的病人在每次访问通过使用医疗记录流程表，其他工具，和工作人员的参与。评价终点：按临床试验机构随机选择的患者在基线时接受最新适应症服务的比例结果：干预中心仅1项服务（乳房自我检查建议）增加较多。在62个中心中，8项目标服务中有7项显著增加。在研究期间，26家中心（42%）的医学主任发生了变化。保持相同的医疗主任在干预centers.Conclusions：癌症早期检测服务的改善，在社区卫生中心，但干预只有一个小的影响，所确定的记录审查。为了产生影响，干预措施要求医疗主任不发生变化。业务环境的变化与提供的服务之间的关系是复杂的，值得进一步研究。
Background: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations.Design/Setting: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers.Intervention: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement.Evaluation End Points: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review.Results: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services.Conclusions: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.