Goldberg H I, Neighbor W E, Cheadle A D, Ramsey S D, Diehr P, Gore E
University of Washington, Department of Medicine, USA.
Health Serv Res. 2000 Mar;34(7):1519-34.
To explore the feasibility of conducting unobtrusive interventional research in community practice settings by integrating firm-system techniques with time-series analysis of relational-repository data.
A satellite teaching clinic divided into two similar, but geographically separated, primary care group practices called firms. One firm was selected by chance to receive the study intervention. Forty-two providers and 2,655 patients participated.
A nonrandomized controlled trial of computer-generated preventive reminders. Net effects were determined by quantitatively combining population-level data from parallel experimental and control interrupted time series extending over two-month baseline and intervention periods.
Mean rates at which mammography, colorectal cancer screening, and cholesterol testing were performed on patients due to receive each maneuver at clinic visits were the trial's outcome measures.
Mammography performance increased on the experimental firm by 154 percent (0.24 versus 0.61, p = .03). No effect on fecal occult blood testing was observed. Cholesterol ordering decreased on both the experimental (0.18 versus 0.1 1, p = .02) and control firms (0.13 versus 0.07, p = .03) coincident with national guidelines retreating from recommending screening for young adults. A traditional uncontrolled interrupted time-series design would have incorrectly attributed the experimental-firm decrease to the introduction of reminders. The combined analysis properly indicated that no net prompting effect had occurred, as the difference between firms in cholesterol testing remained stochastically stable over time (0.05 versus 0.04, p = .75). A logistic-regression analysis applied to individual-level data produced equivalent findings. The trial incurred no supplementary data collection costs.
The apparent validity and practicability of our reminder implementation study should encourage others to develop computerized firm systems capable of conducting controlled time-series trials.
通过将公司系统技术与关系库数据的时间序列分析相结合，探讨在社区实践环境中开展无干扰性干预研究的可行性。
一家卫星教学诊所分为两个类似但地理位置分开的初级保健团队，称为公司。随机选择其中一家公司接受研究干预。42名提供者和2655名患者参与了研究。
一项关于计算机生成的预防性提醒的非随机对照试验。通过对平行实验和对照中断时间序列在两个月基线期和干预期内的人群水平数据进行定量合并来确定净效应。
在诊所就诊时应接受每项检查的患者中进行乳房X线摄影、结肠直肠癌筛查和胆固醇检测的平均比率是试验的结局指标。
实验公司的乳房X线摄影执行率提高了154%（从0.24提高到0.61，p = 0.03）。未观察到对粪便潜血检测的影响。随着国家指南不再推荐对年轻人进行筛查，实验公司（从0.18降至0.11，p = 0.02）和对照公司（从0.13降至0.07，p = 0.03）的胆固醇检测医嘱均减少。传统的非对照中断时间序列设计会错误地将实验公司的减少归因于提醒的引入。综合分析正确表明未发生净促进效应，因为随着时间推移，公司之间胆固醇检测的差异保持随机稳定（0.05对0.04，p = 0.75）。应用于个体水平数据的逻辑回归分析得出了相同的结果。该试验未产生额外的数据收集成本。
我们的提醒实施研究的明显有效性和实用性应鼓励其他人开发能够进行对照时间序列试验的计算机化公司系统。
