Parent Initiated Prevention Program

描述：（由申请人提供）本随机对照试验测试了计算机驱动、以患者为中心的专家系统，以改善为年轻儿科患者提供循证预防。我们建议研究家长发起的实时预防计划（PIPP）在改变初级保健提供者提供预防保健以及家长预防行为方面的有效性。PIPP有两个组成部分：家长教育部分和提供者反馈部分。PIPP与其他提供者干预（包括其他计算机化干预）的不同之处在于，它在健康儿童通过互联网访问之前，根据自己的要求和控制，直接向父母提供针对特定年龄的、基于证据的建议，这些建议可以在家中或在提供者办公室的候诊室访问。此外，它有能力通知提供者家长有兴趣了解更多的主题。使用因子设计来评估其两个组成部分的边际效益，PIPP将在拥有商业电子病历系统的执业网络的四个诊所中部署。我们假设，这种方法将改善预防保健的父母-提供者沟通，并通过赋予家庭权力，它本身可能足以改善预防措施。为了本研究的目的，我们选择关注青春期前的儿童，因为我们认为以青少年为中心的干预将直接针对青少年（而不是他们的父母），因此，不容易被纳入拟议的设计中。我们的三个具体目标和相应的假设是：

DESCRIPTION: (Provided by the Applicant) This randomized controlled trial tests a computer-driven, patient-centered, expert system to improve the provision of evidence-based prevention for young pediatric patients. We propose to study the effectiveness of a real-time Parent-Initiated Prevention Program (PIPP) in changing primary providers' delivery of preventive care as well as parental preventive behaviors. PIPP has two components: a parent educational one and a provider feedback one. PIPP differs from other provider interventions (including other computerized interventions) in that it delivers age specific, evidence-based recommendations directly to parents at their own behest and under their control prior to well-child visits via the Internet, accessed either at home or while in the waiting room of their providers' offices. In addition, it has the capacity to inform providers of the topics that parents are interested in learning more about. Using a factorial design to assess the marginal benefit of both of its components, PIPP will be deployed in four clinics of a practice network that has a commercially available electronic medical record system. We hypothesize that this approach will improve parent-provider communication over preventive health care, and by empowering families, it may be sufficient in itself to improve preventive practices. We have chosen to focus on pre-adolescent children for the purposes of this study because we believe an adolescent-focused intervention would target adolescents directly (rather than their parents) and, therefore, could not easily be included in the proposed design. Our three specific aims and accompanying hypotheses are: (1) To increase the number of evidence-based prevention recommendations that are followed by parents of children aged 0-7 years.H1: Compared to controls, PIPP parents will be more likely to report behaviors consistent with evidence-based prevention for their children. (2) To increase the number of evidence-based prevention topics that are discussed by parents with their children's primary care providers.H2: Compared to controls, PIPP parents will be more likely to report discussing prevention topics with their providers. (3) To improve parental perceptions of the quality of care provided.H3: Compared to controls, PIPP parents will report higher scores on selected Consumer Assessment of Health Plans (CAHPS) items.