Effect of a clinical practice improvement intervention on chlamydial screening among adolescent girls
Effect of a clinical practice improvement intervention on chlamydial screening among adolescent girls
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DOI：
10.1001/jama.288.22.2846
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发表时间：
2002-12-11
影响因子：
120.7
通讯作者：
Bergman, DA
中科院分区：
文献类型：
--
作者：
Shafer, MAB;Tebb, KP;Bergman, DA
背景沙眼衣原体感染是一个严重的公共卫生问题，对青春期女孩的影响尤为严重。尽管卫生专业组织建议每年对性活跃的青春期女孩进行沙眼衣原体筛查，并且是健康雇主数据和信息集（HEDIS）的绩效衡量标准，但这一目标并未实现。临床实践改进干预，旨在通过使用尿液增加沙眼衣原体筛查，设计、设置和参与者在北方加州健康维护组织的Kaiser Permanente的10个儿科诊所的随机分组，从2000年4月到2002年3月，14至18岁的少女共进行了7 920次常规检查。干预随机分配了5家诊所提供常规护理，5家提供干预，这需要领导层通过显示最佳实践与当前实践之间的差距来参与;组建一个团队来支持该项目;通过每月会议确定障碍并制定解决方案;主要指标14- 18岁性活跃人群沙眼衣原体筛查率结果青少年人口种族多样，平均年龄为15.4岁。实验诊所中24%的女孩和对照诊所中23%的女孩性活跃。在干预诊所筛选的1017例患者中，有478例（47%）接受了筛选;在对照诊所筛选的1194例患者中，有203例（17%）接受了筛选。基线时，干预组筛查比例为0.05（95%置信区间[CI]，0.00-0.17），对照组为0.14（95% CI，0.01-0.26）。到第16 - 18个月，干预组的筛查率为0.65（95%CI，0.53-0.77），对照组为0.21（95%CI，0.09-0.33）（研究组相互作用的时间段，F-6.60=5.33; P
Context Chlamydia trachomatis infection is a serious public health concern that disproportionately affects adolescent girls. Although annual C trachomatis screening of sexually active adolescent girls is recommended by health professional organizations and is a Health Employer Data and Information Set (HEDIS) performance measure, this goal is not being met.Objective To test the effectiveness of a system-level, clinical practice improvement intervention designed to increase C trachomatis screening by using urine-based tests for sexually active adolescent girls identified during their routine checkups at a pediatric clinic.Design, Setting, and Participants A randomized cluster of 10 pediatric clinics in the Kaiser Permanente of Northern California health maintenance organization, where adolescent girls aged 14 to 18 years had a total of 7920 routine checkup visits from April 2000 through March 2002.Intervention Five clinics were randomly assigned to provide usual care and 5 to provide the intervention, which required that leadership be engaged by showing the gap between best practice and current practice; a team be assembled to champion the project; barriers be identified and solutions developed through monthly meetings; and progress be monitored with site-specific screening proportions.Main Outcome Measure Chlamydia trachomatis screening rate for sexually active 14- to 18-year-old girls during routine checkups at each participating clinic.Results The population of adolescents was ethnically diverse with an average age of 15.4 years. Twenty-four percent of girls in the experimental clinics and 23% in the control clinics were sexually active. Of the 1017 patients eligible for screening in the intervention clinic, 478 (47%) were screened; of 1194 eligible for screening in the control clinic, 203 (17%) were screened. At baseline, the proportion screened was 0.05 (95% confidence interval [CI], 0.00-0.17) in the intervention and 0.14 (95% CI, 0.01-0.26) in the control clinics. By months 16 to 18, screening rates were 0.65 (95% CI, 0.53-0.77) in the intervention and 0.21 (95% CI, 0.09-0.33) in the control clinics (time period by study group interaction, F-6.60=5.33; P