Promoting screening mammography in inner-city settings - The sustained effectiveness of computerized reminders in a randomized controlled trial
Promoting screening mammography in inner-city settings - The sustained effectiveness of computerized reminders in a randomized controlled trial
复制标题
DOI：
10.1097/00005650-199709000-00005
复制
发表时间：
1997-09-01
期刊：
影响因子：
3
通讯作者：
Gimotty, PA
中科院分区：
文献类型：
--
作者：
Burack, RC;Gimotty, PA
目标.作者进行了一项随机对照试验，以评估在持续干预的第二年，在底特律的卫生部门和健康维护组织的三个初级保健实践中，计算机提醒系统在促进乳房X线摄影方面的持续有效性。所有参与者均无需自付乳房X线摄影费用（有限干预）。在预产期前1个月（全面干预），将计算机生成的提示信息放入应进行乳房X光检查的妇女的病历中，以促进医生转诊进行乳房X光检查。在1，225名2岁的来访者中，在卫生部门进行全面干预的乳房X光检查率为44%，而进行有限干预的乳房X光检查率为28（完全干预效果的调整比值比[OR]为1.84; 95%置信区间[CI]：1.40-2.40），在健康维护组织中，完全干预为45%，有限干预为46%（调整后OR 1.06; 95%CI 0.80-1.42）。第二年的结果与第一年的结果形成对照，在第一年期间，两个组织都显示出充分干预的显著效果。在控制了患者特征和地点后，完全干预的效应量在第二年与第一年相比显著降低（P = 0.05）。计算机化乳房X线摄影提醒的效果可以在持续干预的第二年持续下去，但个别实践地点和组织对干预的反应各不相同。促进定期和重复使用程序的战略必须确定和解决影响其有效性的随时间变化的障碍。
OBJECTIVES. The authors conducted a randomized controlled trial to evaluate the sustained effectiveness of a computerized reminder system in promoting mammography during a second year of continuing intervention at three primary care practices of a Health Department and a health maintenance organization in Detroit, Michigan.METHODS. Out-of-pocket mammography cost was eliminated for all participants (limited intervention). Computer-generated reminders promoting physician referral for mammography were placed in the medical records of women due for mammography 1 month in advance of their due date (full intervention).RESULTS. Among 1,225 year 2 visitors, mammography rates were 44% for full intervention versus 28% for limited intervention at the health department (adjusted odds ratio [OR] for effect of full intervention 1.84; 95% confidence interval [CI]: 1.40-2.40) and 45% for full versus 46% for limited at the health maintenance organization (adjusted OR 1.06; 95% CI 0.80-1.42). These second year results contrasted with those observed for year 1, during which a significant effect of full intervention was demonstrated for both organizations. After controlling for patient characteristics and site, the effect sizes of full intervention were reduced significantly in the second year compared with the first year (P = 0.05).CONCLUSIONS. The effect of computerized mammography reminders can be sustained in a second year of continued intervention, but individual practice sites and organizations vary in their responsiveness to the intervention. Strategies to promote periodic and repetitive procedure use must identify and address time-varying barriers to their effectiveness.