Wagner T H, Hibbard J H, Greenlick M R, Kunkel L
VA HSR&D Health Economics Resource Center, Center for Primary Care and Outcomes Research, and Center for Health Policy, Stanford University, CA, USA.
Med Care. 2001 Aug;39(8):836-47. doi: 10.1097/00005650-200108000-00009.
To determine whether providing health information to residents of Boise ID had an effect on their self-reported medical utilization.
The Healthwise Communities Project (HCP) evaluation followed a quasi-experimental design.
Random households in metropolitan zip codes were mailed questionnaires before and after the HCP. A total of 5,909 surveys were returned.
The dependent variable was self-reported number of visits to the doctor in the past year. A difference-in-differences estimator was used to assess the intervention's community-level effect. We also assessed the intervention's effect on the variance of self-report utilization.
Boise residents had a higher adjusted odds of entering care (OR = 1.27, 95% CI 0.88, 1.85) and 0.1 more doctor visits compared with residents in the control cities; however, for both outcomes, the effects were small and not significant. Although the means changed little, the data suggest that the variance of utilization in Boise decreased.
The HCP had a small effect on overall self-reported utilization. Although the findings were not statistically significant, a posthoc power analysis revealed that the study was underpowered to detect effects of this magnitude. It may be possible to achieve larger effects by enrolling motivated people into a clinical trial. However, these data suggest that population-based efforts to provide health information have a small effect on self-reported utilization.
确定向爱达荷州博伊西市居民提供健康信息是否会对他们自我报告的医疗利用情况产生影响。
健康明智社区项目（HCP）评估采用了准实验设计。
在HCP开展前后，向大都市邮政编码区域内的随机家庭邮寄问卷。共收回5909份调查问卷。
因变量是过去一年中自我报告的看医生次数。采用差异中的差异估计量来评估干预措施在社区层面的效果。我们还评估了干预措施对自我报告利用情况方差的影响。
与对照城市的居民相比，博伊西市居民接受医疗服务的调整后几率更高（比值比=1.27，95%置信区间0.88，1.85），且看医生的次数多0.1次；然而，对于这两个结果，影响都很小且不显著。尽管均值变化不大，但数据表明博伊西市医疗利用情况的方差有所下降。
HCP对总体自我报告的医疗利用情况影响较小。尽管研究结果在统计学上不显著，但事后功效分析表明该研究检测这种程度影响的功效不足。通过招募有积极性的人参与临床试验可能会取得更大的效果。然而，这些数据表明基于人群提供健康信息的努力对自我报告的医疗利用情况影响较小。
