DISTRIBUTED OCCUPATIONAL KNOWLEDGE SYSTEM

职业健康在初级保健环境中受到的关注太少；此外，公共卫生监测在临床环境中获取和利用的信息太少。获得适当的职业史需要时间和职业医学方面的专业知识，而这两种知识在大多数初级保健环境中都是不够的。DOKS(分布式职业知识系统)通过开发一个计算机辅助系统来解决这些问题，该系统可直接纳入常规初级保健服务。它获得了计算机辅助的职业史，并为预防干预提出了针对具体情况的建议。它还将系统地收集临床信息，用于公共卫生分析。该系统将在三个不同的卫生门诊护理环境中实施--以县医院为基础的、健康维护机构和诊所集团。最初，面试将是面对面的，然后是电话，然后是电脑。向患者和临床护理提供者提供建议。评估包括历史控制和同时控制，并基于离职和3个月的面谈和记录审查。这一过程还产生了有价值的监测数据，包括经常被其他方法遗漏的人口部分，并描述了工作的功能影响，而不仅仅是职业引起的疾病。

Occupational health receives too little attention in primary care settings; in addition, public health surveillance acquires and utilizes too little of the information available in clinical settings. Obtaining an appropriate occupational history requires both time and expert knowledge about occupational medicine, both of which are inadequate in most primary care settings. The DOKS (Distributed Occupational Knowledge System addresses these problems by developing a computer assisted system, which may be directly incorporated in routine primary health care delivery. It obtains a computer assisted occupational history and makes case specific recommendations for preventive interventions. It will also systematically collect clinical information for public health analysis. The system will be implemented in three different health ambulatory care settings- county hospital based, health maintenance organization, and clinic group. Initially, interviews will be in person, then by phone, and later by computer. Recommendations are provided to patients and clinical care providers. Evaluation includes historical and concurrent controls and is based on exit and 3 month interviews and record review. The process also yields valuable surveillance data including population segments often missed by other methods and describing functional impact of work rather than just occupationally caused disease.