EVALUATING COMPUTER DECISION SUPPORT FOR PREVENTIVE CARE

描述：项目的具体目标是：1)扩展和修改 以现有指引为基础的电脑化儿童预防服务 儿科办公室日常使用的决策支持系统(芯片) 实践；2)评估系统对患者过程的影响 私人儿科诊所的护理(特别是依从率 筛查方案和预防咨询内容)；3) 评估该系统对私下病人护理结果的影响 实践(特别关注服务提供的比率，由 家长对医疗服务提供者行为及自身预防知识的了解 服务，以及参与者的知识和态度 儿科医生)。 本项目的自变量是实践特征， 提供者特征和患者[12至24岁的儿童 月]特征。干预是芯片的引入 系统分为两个实践，两个实践作为控制。这个 该项目建议衡量三类因变量，健康 护理交付结果、预防性护理的机会和医生， 工作人员和患者(家长)的知识和态度。的主要关注点 医疗保健提供结果是以下方面的完成率 适合年龄的服务，包括免疫接种、贫血筛查、 结核病、铅、视力问题等，关于危险因素的评估和教育 如汽车安全座椅、二手烟烟雾暴露等。 项目方法从修改现有的计算机化的 儿童预防服务决策支持系统，作为一个 用于北卡罗来纳大学医院和 卫生局。修改将确保主服务器的功能 护理办公室环境。评估部分的研究设计(AIMS 2 和3)包括两套匹配的儿科实践，以提供两个 试验点和两个对照实习点，随机抽样 病人都是从每个人身上抽取的。广义估计方程(GEE)将是 用来检验主要假设。 数据来源包括使用计算机化版本的病历摘要 在首席调查员的父母处为先前的研究开发的表格 机构，对初级保健提供者和办公室工作人员的调查，以及调查 儿科病人的父母。对提供者和工作人员的调查 将在评估之前进行管理，以建立基线和 干预后12个月。调查工具将类似于 以前用来对目标效果进行初步评估的指标 芯片系统。父母也将通过电话采访接受调查， 收集基线数据和干预后12个月的数据。 然而，根据研究计划，父母接触者的样本量 在每个年龄段中，[将]仅大到足以察觉不同的 练习。“

DESCRIPTION: The specific aims of the project are: 1) to expand and modify an existing guidelines based computerized childhood preventive services decision support system (CHIP) for everyday use in pediatric office practices; 2) to evaluate the effect of the system on the process of patient care in private pediatric practices (specifically looking at adherence rates of screening protocols and the content of preventive counseling); 3) to evaluate the effect of the system on outcomes of patient care in private practices (specifically looking at rates of service delivery, reporting by parents about provider behaviors and their own knowledge about preventive services, and the knowledge and attitudes of the participating pediatricians). The independent variables of this project are practice characteristics, provider characteristics, and patient [children between the ages of 12 to 24 months] characteristics. The intervention is the introduction of the CHIP system into two practices, with two practices serving as controls. The project proposes to measure three categories of dependent variables, health care delivery outcomes, opportunities for preventive care, and physician, staff and patient (parent) knowledge and attitudes. The primary focus of the health care delivery outcomes is the completion rates for age-appropriate services, including immunizations, screenings for anemia, TB, lead, vision problems, etc., assessment and education about risk factors such as car safety seats, second-hand tobacco smoke exposure, etc. The project methodology begins with modification of an extant computerized childhood preventive services decision support system, developed as a prototype system for use at the University of North Carolina Hospital and the health department. Modifications will insure functionality in a primary care office setting. The study design for the evaluation component (aims 2 and 3) includes two sets of matched pediatric practices, to provide two experimental and two control practice sites, with a random sample of patients drawn from each. Generalized estimating equations (GEE) will be used to test the primary hypothesis. Data sources include medical record abstraction using computerized versions of forms developed for prior research at the principal investigator's parent institution, surveys of primary care providers and office staff, and surveys of parents of the pediatric patients. Surveys of the providers and staff will be administered prior to the evaluation to establish a baseline and twelve months post-intervention. Survey instruments will be similar to those previously used to provide primary evaluation on targeted effects of the CHIP system. Parents will also be surveyed, using telephone interviews, to collect baseline data and at the twelve months post-intervention period. However, according to the research plan, the sample size for parent contacts "in each age group [will be] only large enough to detect differences across practices."