DIRECT OBSERVATION OF PRIMARY CARE PRACTICE

直接观察初级保健实践

• 批准号: 2101637
• 负责人: KURT C STANGE
• 金额: $ 75.06万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-05-01 至 1996-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2101637
• 关键词: disease /disorder prevention /control; health care service evaluation; human subject; interview; patient care management; primary care physician; questionnaires

The U.S. Preventive Services Task Force (USPSTF) and the Healthy People 2000 reports call for primary care physicians to adopt a new paradigm of clinical preventive practice. Previous research has documented a relatively weak performance in actual delivery of many preventive services. Limitations of prior work include a poorly detailed understanding of the competing demands of primary care practice and potentially inaccurate methods for measuring the delivery of preventive services, particularly counseling. The proposed study will examine the practices of 120 family physician members of the Research Association of Practicing Physicians (RAPP). Four study teams of two nurse-researchers each will evaluate the provision of care to consecutive patients during two separate days at each of the study practices. Chart audit and patient exit questionnaires will be used to measure the baseline prevalence of preventive services delivered, and the eligibility for additional services by USPSTF age-gender specific recommendations. The incidence of delivery of preventive services will be assessed with direct observation of the medical encounter. In addition, the Davis Observation Code will be used to characterize the time spent on various activities during the medical encounter. Other potential determinants of preventive service delivery to be examined will include characteristics of physicians, patients, the medical encounter, and the office environment. Descriptive analyses will profile the time spent in the different activities of the medical encounter. The level of delivery of USPSTF- recommended preventive services will be determined for individual services and for the aggregate categories of counseling, screening, immunization, and chemoprophylaxis services. In addition, the concordance of medical record review, patient exit questionnaire, and physician questionnaire about usual practices, will be compared with direct observation measures for individual and aggregate categories of preventive services. Finally, characteristics of the medical encounter, physician, patient and the practice environment, that are associated with preventive service delivery will be assessed. Content analysis of data from brief ethnographic observations and modified focus groups of the nurse observers will enhance interpretation of study findings and enlighten the development of new hypotheses about ways to increase preventive service delivery. The proposed study will provide previously unavailable data about delivery of preventive services, particularly counseling services, by physicians within the competing demands of the medical encounter. Data on how time is actually spent during the medical encounter will be useful for efforts to implement practice guidelines and to determine how well payment systems, such as the new RBRVS-based Medicare system, reflect actual practice. The study will provide a unique base of information from which to develop innovative new methods to increase preventive service delivery by primary care physicians.

美国预防服务工作组（USPSTF）和健康人群 2000年的报告呼吁初级保健医生采用一种新的模式， 临床预防实践。以前的研究记录了一个 许多预防性措施的实际执行情况相对较弱， 服务以前工作的局限性包括一个不详细的 了解初级保健实践的竞争需求， 衡量预防性措施提供情况的方法可能不准确， 服务，特别是咨询。 这项拟议的研究将检查120名家庭医生的实践 执业医师研究协会（RAPP）。四 由两名护士研究人员组成的研究小组将评估 在每次研究的两个不同的日子里对连续患者进行护理 实践图表审核和患者退出问卷将用于 衡量所提供预防服务的基线普及率， 按USPSTF年龄-性别分列的额外服务资格 建议.提供预防服务的发生率将 通过直接观察医疗事件进行评估。此外，本发明还提供了一种方法， 戴维斯观察代码将用于描述花费在 医疗过程中的各种活动。其他潜在 将审查的提供预防性服务的决定因素包括 医生、患者、医疗遭遇和 办公环境。 描述性分析将描述在不同时间段花费的时间， 医疗遭遇的活动。USPSTF的交付水平- 将为每项服务确定推荐的预防服务 以及咨询，筛查，免疫接种， 和化学预防服务。此外，医学的一致性 记录审查、患者退出问卷和医生问卷 关于通常的做法，将与直接观察措施进行比较 预防服务的个别和综合类别。最后， 医疗遭遇的特点，医生，病人和 实践环境，与预防性服务提供相关 将予以评估。简要民族志资料的内容分析 护士观察员的观察和修改后的焦点小组将加强 研究结果的解释和启发新的发展 关于如何增加预防性服务提供的假设。 拟议的研究将提供以前无法获得的有关分娩的数据 预防服务，特别是咨询服务，由医生 在医疗冲突的竞争需求中。关于时间的数据 在医疗过程中实际花费的时间将有助于努力 执行实践指南，并确定支付系统， 例如新的基于RBRVS的医疗保险制度，反映了实际做法。的 研究将提供一个独特信息基础， 以创新的新方法增加初级保健机构提供的预防服务 护理医生