EVALUATING COMPUTER DECISION SUPPORT FOR PREVENTIVE CARE

评估预防保健的计算机决策支持

• 批准号: 2546269
• 负责人: STEPHEN M DOWNS
• 金额: $ 35.92万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-09-30 至 1999-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2546269
• 关键词: clinical research; computer assisted medical decision making; disease /disorder prevention /control; health care service evaluation; health care service utilization; human subject; immunization; information systems; mass screening; medical records; pediatrics; population survey; therapy compliance

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."

描述：该项目的具体目标是：1）扩展和修改 基于现有指南的计算机化儿童预防服务 儿科办公室日常使用的决策支持系统 (CHIP) 做法； 2）评估系统对患者治疗过程的影响 私人儿科诊所的护理（特别关注依从率 筛查方案和预防性咨询的内容）； 3）到 评估该系统对私人患者护理结果的影响 实践（特别关注服务提供率、报告 家长了解提供者的行为以及他们自己的预防知识 服务、参与人员的知识和态度 儿科医生）。 该项目的自变量是实践特征， 提供者特征和患者 [12 至 24 岁之间的儿童 月]特点。 干预措施是引入 CHIP 系统分为两个实践，两个实践作为控制。 这 项目建议衡量三类因变量：健康 护理提供结果、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。 主要关注点是 医疗保健提供结果是完成率 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，危险因素评估和教育 例如汽车安全座椅、二手烟草烟雾暴露等。 该项目方法从修改现有的计算机化系统开始 儿童预防服务决策支持系统，作为 北卡罗来纳大学医院使用的原型系统 卫生部门。 修改将确保主要功能 护理办公室设置。 评估部分的研究设计（目标 2 3) 包括两套匹配的儿科实践，以提供两种 实验和两个对照实践地点，随机抽样 从每个中抽取患者。 广义估计方程（GEE）将是 用于检验主要假设。 数据源包括使用计算机化版本的病历摘要 为主要研究者的父母之前的研究开发的表格 机构、初级保健提供者和办公室工作人员的调查以及调查 儿科患者的父母。 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 干预后十二个月。 调查工具将类似于 以前用于对目标效果进行初步评估的 芯片系统。 还将通过电话访谈对家长进行调查， 收集基线数据以及干预后十二个月的数据。 不过，根据研究计划，家长接触的样本量 “在每个年龄组中，[将]仅大到足以检测不同年龄组之间的差异 的做法。”