Fihn Stephan D, McDonell Mary B, Diehr Paula, Anderson Stephen M, Bradley Katharine A, Au David H, Spertus John A, Burman Marcia, Reiber Gayle E, Kiefe Catarina I, Cody Marisue, Sanders Karen M, Whooley Mary A, Rosenfeld Kenneth, Baczek Linda A, Sauvigne Arthur
Northwest VA Health Services Research & Development Center of Excellence, Seattle, Washington 98108, USA.
Am J Med. 2004 Feb 15;116(4):241-8. doi: 10.1016/j.amjmed.2003.10.026.
Because limited audit/feedback of health status information has yielded mixed results, we evaluated the effects of a sustained program of audit/feedback on patient health and satisfaction.
We conducted a group-randomized effectiveness trial in which firms within Veterans Administration general internal medicine clinics served as units of randomization, intervention, and analysis. Respondents to a baseline health inventory were regularly mailed the 36-Item Short Form (SF-36) and, as relevant, questionnaires about six chronic conditions (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, depression, alcohol use, and hypertension) and satisfaction with care. Data were reported to primary providers at individual patient visits and in aggregate during a 2-year period.
Baseline forms were mailed to 34,050 patients; of the 22,413 respondents, 15,346 completed and returned follow-up surveys. Over the 2-year study, the difference between intervention and control groups (as measured by difference in average slope) was -0.26 (95% confidence interval [CI]: -0.79 to 0.27; P=0.28) for the SF-36 Physical Component Summary score and -0.53 (95% CI: -1.09 to 0.03; P=0.06) for the SF-36 Mental Component Summary score. No significant differences emerged after adjusting for deaths. There were no significant differences in condition-specific measures or satisfaction between groups after adjustment for provider type, panel size, and number of intervention visits, or after analysis of patients who completed all forms.
An elaborate, sustained audit/feedback program of general and condition-specific measures of health/satisfaction did not improve outcomes. To be effective, such data probably should be incorporated into a comprehensive chronic disease management program.
由于对健康状况信息的有限审核/反馈产生了好坏参半的结果，我们评估了一项持续的审核/反馈计划对患者健康和满意度的影响。
我们进行了一项群组随机有效性试验，其中退伍军人事务部普通内科诊所内的公司作为随机分组、干预和分析的单位。对基线健康状况调查表的受访者定期邮寄36项简短健康调查量表（SF-36），以及相关的关于六种慢性病（缺血性心脏病、糖尿病、慢性阻塞性肺疾病、抑郁症、酒精使用和高血压）和护理满意度的问卷。数据在个体患者就诊时报告给初级医疗服务提供者，并在两年期间汇总报告。
向34,050名患者邮寄了基线表格；在22,413名受访者中，15,346人完成并返回了随访调查。在为期两年的研究中，干预组和对照组之间（以平均斜率差异衡量）的差异在SF-36身体成分汇总得分方面为-0.26（95%置信区间[CI]：-0.79至0.27；P = 0.28），在SF-36心理成分汇总得分方面为-0.53（95%CI：-1.09至0.03；P = 0.06）。在对死亡情况进行调整后，未出现显著差异。在对提供者类型、患者小组规模和干预就诊次数进行调整后，或在对完成所有表格的患者进行分析后，两组在特定病情指标或满意度方面均无显著差异。
一项精心设计的、持续的针对总体和特定病情的健康/满意度衡量指标的审核/反馈计划并未改善结果。要想有效，此类数据可能应纳入全面的慢性病管理计划中。
