VIDEODISC FOR BACK SURGERY DECISIONS: A RANDOMIZED TRIAL

研究小组已经准备了一个使用Interactive的教育计划 媒体(电脑和视盘)帮助腰痛患者 对于接受背部手术，疾病会做出更明智的决定。背 对于这种教育干预来说，疼痛是一个理想的问题， 由于这非常普遍，医疗费用很高(超过24美元 每年10亿美元)，背部手术几乎总是一种选择性手术 其主要好处是加速了症状的缓解。影碟节目 根据患者的年龄提供个性化的演示 和诊断，并提供有关以下方面的最佳可用信息 手术和非手术护理的预期治疗结果。它包括 来自经历了好的和坏的结果的实际患者的评论 从他们的治疗选择中。研究人员现在提出了一种随机的 评估该方案对患者功能状态的影响； 对医疗服务的满意度；有关腰背部问题的知识 做出明智的选择；选择手术治疗的可能性；以及 卫生保健利用情况。 这项试验将比较下腰痛视频光盘节目和书面 教育材料作为对腰痛的常规护理的补充。 随机分配到对照组的患者将接受专门的 设计了关于腰部问题的患者治疗选择的小册子。 视盘干预组中的受试者观看视频节目并 收到他们所看到的数据的打印表。这项研究将是 在两个地点进行：封闭式小组医疗保健组织(受试者将在 通过初级保健诊所的外科转介来识别)；以及费用- 以服务为目的的学术外科实践。遵循教育 将评估干预措施、患者的知识和态度，以及 记录治疗选择。然后，患者将在3点接受随访。 和12个月来确定他们的健康状况，功能， 满意度和卫生保健利用率。我们预计总共有 600名受试者将被录取并随机分配。因为 不同的实践点，结果应该广泛推广，并且 将有一些机会来评估这一政策的影响 视盘在不同类型的实践中各不相同。如果新的视盘 教育技术被证明是有效的，它将服务于提高耐心 自主并赋予患者在医疗保健决策方面的权力。它可能 也要修改手术率，因为患者在其他环境中已经证明了 比外科医生更厌恶风险，有时会有所不同 治疗选择。

The research team has prepared an educational program using interactive media (both computer and videodisc) to help patients with low back disorders make more informed decisions about undergoing back surgery. Back pain is an ideal problem for this type of educational intervention, because it is extremely common, health care costs are high (over $24 billion a year), and back surgery is almost always an elective procedure whose major benefit is accelerated symptom relief. The videodisc program provides an individualized presentation, depending on the patient's age and diagnosis, and provides the best available information regarding expected treatment outcomes of surgical and nonsurgical care. It includes commentary from actual patients who have experienced good and bad outcomes from their treatment choices. The investigators now propose a randomized trial to evaluate the impact of this program on patient functional status; satisfaction with medical care; knowledge of low back problems relevant to making informed choices; likelihood of selecting surgical therapy; and health care utilization. This trial will compare the low back pain videodisc program to written educational materials as adjuncts to usual care for low back pain. Patients randomly allocated to the control group will receive a specially designed brochure on patient treatment choices for low back problems. Subjects in the videodisc intervention group view the video program and receive a printed table of the data they have seen. The study will be conducted in two sites: a closed-panel HMO (where subjects will be identified by surgical referrals from primary care practice); and a fee- for-service academic surgical practice. Following the educational intervention, patient knowledge and attitudes will be assessed, and treatment choices recorded. Patients will then receive follow-up at three and twelve months to determine their health status, function, satisfaction, and health care utilization. We anticipate that a total of 600 subjects will be enrolled and randomly allocated. Because of the different practice sites, the results should be widely generalizable, and there will be some opportunity to assess whether the impact of the videodisc varies in different types of practices. If the new videodisc educational technology proves effective, it will serve to enhance patient autonomy and empower patients in their health care decision-making. It may also modify surgical rates, since patients have proven in other settings to be more risk averse than surgeons, and sometimes make different treatment choices.