Myers Ronald E, Turner Barbara, Weinberg David, Hyslop Terry, Hauck Walter W, Brigham Timothy, Rothermel Todd, Grana James, Schlackman Neil
Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Prev Med. 2004 Apr;38(4):375-81. doi: 10.1016/j.ypmed.2003.11.010.
Complete diagnostic evaluation or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium enema X-ray) is often not performed for persons with an abnormal screening fecal occult blood test (FOBT+) result.
This study evaluated the impact of a reminder-feedback and educational outreach intervention on primary care practice CDE recommendation and performance rates. Four hundred seventy primary care physicians (PCPs) in 318 practices participated in the study. Patients were mailed an FOBT kit annually as part of a screening program. Practices were randomly assigned to a Control Group (N = 198) or an Intervention Group (N = 120). During an 18-month pre-randomization period and a 9-month post-randomization period, 2992 screening FOBT+ patients were identified. Intervention practices received the screening program and the intervention. Control practices received only the screening program. Study outcomes were baseline-adjusted CDE recommendation and performance rates.
At baseline, about two-thirds of FOBT+ patients received a CDE recommendation, and about half had a CDE performed. At endpoint, CDE recommendation and performance rates were both significantly higher for the Intervention as compared to the Control practices (OR = 2.28; 95% CI: 1.37, 3.78, and OR = 1.63; 95% CI: 1.06, 2.50, respectively).
The reminder-feedback plus educational outreach intervention significantly increased CDE recommendation and performance.
对于粪便潜血试验筛查结果异常（FOBT+）的患者，通常不进行完整的诊断评估或CDE（即结肠镜检查或柔性乙状结肠镜检查加钡灌肠X线检查）。
本研究评估了提醒-反馈和教育外展干预对初级保健机构CDE推荐率和执行率的影响。318家机构的470名初级保健医生（PCP）参与了研究。作为筛查项目的一部分，每年向患者邮寄一份FOBT检测试剂盒。机构被随机分为对照组（N = 198）或干预组（N = 120）。在18个月的随机分组前期和9个月的随机分组后期，共识别出2992名FOBT+筛查患者。干预组机构接受筛查项目和干预措施。对照组机构仅接受筛查项目。研究结果为经基线调整的CDE推荐率和执行率。
在基线时，约三分之二的FOBT+患者收到了CDE推荐，约一半的患者接受了CDE检查。在研究终点，与对照组相比，干预组的CDE推荐率和执行率均显著更高（OR = 2.28；95%CI：1.37，3.78；以及OR = 1.63；95%CI：1.06，2.50）。
提醒-反馈加教育外展干预显著提高了CDE推荐率和执行率。
