Chande V T, Kimes D
Department of Pediatrics, University of Pittsburgh, Children's Hospital of Pittsburgh, PA, USA.
Acad Emerg Med. 1999 Aug;6(8):823-7. doi: 10.1111/j.1553-2712.1999.tb01215.x.
To determine whether implementation of an intervention based on a model of health promotion will encourage patients to seek care from their primary care provider (PCP) and reduce visits to the pediatric ED (PED) for minor illness.
Prospective, randomized, controlled study in the PED of an urban children's hospital (CH). Children <13 months old, enrolled in a Medicaid managed care plan, who identified the CH as their site for primary care and presented to the PED for evaluation of minor illness were enrolled after being seen by the triage nurse, before being seen by a physician. Subjects were randomly assigned to the intervention (I) group or control (C) group. Parents of all enrollees completed a survey about health care utilization habits. Each family in the I group received health promotion teaching from a single investigator. The intervention consisted of a review of the child's medical record with the parents, an explanation of what to expect at future well-child visits, and a discussion of the role of the PCP. A follow-up appointment was also provided prior to discharge from the PED. The C group received usual care. Use of health care by all subjects was tracked for one year by medical record review and phone interviews at six and 12 months.
102 subjects in the I group and 93 in the C group (mean +/- SD ages 6.4 months +/- 3.8 and 7.2 months +/- 3.9, respectively, p = 0.15) were enrolled from March 1996 to November 1996. The two groups were similar with respect to demographics and overall health status at enrollment. At study entry: 94 of 102 (92%) subjects in I and 87 of 93 (94%) in C had made at least one visit to the PED in the previous 12 months (p = 0.11); 95 of 102 (93%) in I and 75 of 93 (81%) in C had seen their PCP at least once for well-child care (p = 0.24). Twelve-month follow-up by medical record review was completed for all subjects; phone interviews were completed in 90 of 102 (88%) in I and 80 of 93 (86%) in C. At 12-month follow-up: 84 of 102 (82%) in I and 73 of 93 (78%) in C had made at least one visit to the PED (p = 0.59); 81 of 102 (79%) in I and 77 of 93 (83%) in C had made at least one visit to their CH PCP (p = 0.54).
There was no difference in health care utilization between the intervention and control groups at 12-month follow-up. The health promotion intervention did not alter utilization habits.
确定基于健康促进模式实施的干预措施是否会鼓励患者向其初级保健提供者（PCP）寻求治疗，并减少因小病前往儿科急诊科（PED）就诊的次数。
在一家城市儿童医院（CH）的儿科急诊科进行前瞻性、随机、对照研究。纳入参加医疗补助管理式医疗计划、将该儿童医院确定为其初级保健机构且因小病前往儿科急诊科接受评估的13个月以下儿童，这些儿童在经分诊护士检查后、医生诊治前被纳入研究。受试者被随机分配至干预（I）组或对照组（C）。所有入选者的家长均完成了一份关于医疗保健利用习惯的调查问卷。I组的每个家庭均由一名研究人员进行健康促进教学。干预措施包括与家长一起查看孩子的病历、解释未来定期儿童健康检查的内容以及讨论初级保健提供者的作用。在从儿科急诊科出院前还提供了一次随访预约。C组接受常规护理。通过病历审查以及在6个月和12个月时进行电话访谈，对所有受试者的医疗保健使用情况进行了为期一年的跟踪。
1996年3月至1996年11月，I组有102名受试者，C组有93名受试者（平均年龄±标准差分别为6.4个月±3.8个月和7.2个月±3.9个月，p = 0.15）被纳入研究。两组在入组时的人口统计学特征和总体健康状况相似。在研究开始时：I组102名受试者中的94名（92%）和C组93名受试者中的87名（94%）在过去12个月中至少去过一次儿科急诊科（p = 0.11）；I组102名受试者中的95名（93%）和C组93名受试者中的75名（81%）至少因儿童健康检查看过一次初级保健提供者（p = 0.24）。对所有受试者均完成了为期12个月的病历审查随访；I组102名受试者中的90名（88%）和C组93名受试者中的80名（86%）完成了电话访谈。在12个月随访时：I组102名受试者中的84名（82%）和C组93名受试者中的73名（78%）至少去过一次儿科急诊科（p = 0.59）；I组102名受试者中的81名（79%）和C组93名受试者中的77名（83%）至少去过一次其儿童医院的初级保健提供者处（p = 0.54）。
在12个月随访时，干预组和对照组在医疗保健利用方面没有差异。健康促进干预未改变利用习惯。
