COMPUTER BASED DOCUMENTATION AND PROVIDER INTERACTION

用于在线记录的程序已经成为基于计算机的患者记录的流行补充。这些工具中的大多数使用个人计算机和屏幕上的表单来构建患者探视记录。在儿科初级保健或家庭实践环境中，这些计划可能会改善对适合年龄的筛查、发育测试和免疫接种指南的遵从性。计算机还可以提醒提供商要解决的问题，并将帮助确保完整的文档。然而，基于计算机的文档(CBD)可能会分散提供者、患者或家长的注意力。电脑可能会让父母感到与那些将注意力集中在电脑上输入数据的提供者疏远。计算机可能会导致花费更多的时间来完成文档。不幸的是，没有对照研究评估CBD对初级保健实践环境中的健康维护接触的质量的影响。本项目的目的是评估使用基于特定年龄段的就诊指南的在线文件工具如何影响就诊的质量，以就诊期间解决的心理社会和前瞻性指导问题的数量、父母和提供者对就诊的满意度以及就诊的持续时间来衡量。这些结果将根据记录遭遇的不同模式(在访问期间、访问后、临床会议结束时)进行评估。这项研究采用了干预前后的设计。控制组包括与家庭的接触，这些家庭在CBD实施之前见过。干预组包括两年后--《生物多样性公约》实施一年后的相遇。这项研究的对象是18个月以下的儿童，他们被看做是“良好的儿童护理”。每一次相遇都会被录音。在会面结束时，提供者和家属都被要求完成一项离职调查，以评估他们对会面的满意度。提供者还被要求描述他们在这次访问中是如何使用CBD的，并评估电子模板对这次患者会诊的用处。有关这次会面的内容和提供者的沟通方式的数据将通过使用名为Roter互动分析系统的工具对录音带进行分析而获得，该工具提供对患者、提供者和计算机互动的可靠和有效的分析。患者和提供者的满意度数据将从退出调查的分析中得出。

Programs for on-line documentation have become a popular addition to computer-based patient records. Most of these tools use personal computers and on-screen forms to construct a patient visit note. In a pediatric primary care or family practice setting, these programs potentially can improve compliance with age-appropriate screening, developmental testing, and immunization delivery guidelines. The computer also may remind the provider about issues to address and will help ensure complete documentation. However, computer-based documentation (CBD) may distract the provider, the patient, or the parent. Computers might cause parents to feel distanced from providers who focus attention on the computer to enter data. Computers might result in more time being spent completing documentation. Unfortunately, there are no controlled studies that have evaluated the effect of CBD on the quality of the health- maintenance encounter in a primary care practice setting. The aim of this project is to evaluate how using online documentation tools based on age-specific encounter guidelines for pediatric health-maintenance visits affects the quality of the encounter, as measured by the number of psychosocial and anticipatory guidance issues addressed during a visit, the parent and provider satisfaction with the encounter, and the duration of the encounter. These results will be evaluated with respect to different patterns of documenting the encounter (during the visit, after the visit, at the end of the clinic session.) The study utilizes a pre and post intervention design. The control group consists of encounters with families seen before the implementation of CBD. The intervention group consists of encounters that occurred two years later-1 year after the implementation of CBD. The study includes children under the age of 18 months, being seen for "well-child care." Each encounter is audiotaped. At the conclusion of the encounter, both the provider and the family are asked to complete an exit survey that assesses their satisfaction with the encounter. Providers also are asked to describe how they used CBD during this visit, and to assess how useful the electronic template was for this patient encounter. Data about the encounter's content and the provider's communication style will be obtained through an analysis of the audiotapes using a tool called the Roter Interactional Analysis System, which provides a reliable and valid analysis of patient, provider, computer interaction. Patient and provider satisfaction data will be derived from analysis of the exit survey.