Silverstein Michael, Mack Christopher, Reavis Nicole, Koepsell Thomas D, Gross Gregory S, Grossman David C
Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Mass 02118, USA.
JAMA. 2004 Aug 25;292(8):968-71. doi: 10.1001/jama.292.8.968.
Early childhood development programs such as Head Start have proven benefits for impoverished children. However, few physicians assist families with enrollment.
To test if a primary care-based intervention is efficacious in increasing Head Start attendance.
DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 246 Head Start-eligible children aged 0 through 4 years recruited in spring 2003 from 4 health clinics in Seattle, Wash.
List of Head Start telephone contacts provided to families of all children and, for those in the intervention group, a computer-generated packet containing a physician referral letter (and a physical examination form and immunization record, if available) mailed directly to Head Start by study personnel.
Head Start attendance by January 2004.
The 123 children analyzed in each study group were similar at baseline. Overall, 72 children (29%) were successfully connected with Head Start (ie, actively attending or on a waiting list) by January 2004. Among the intervention group, 50 children (41%) were successfully connected with Head Start, contrasted with 22 (18%) in the control group (adjusted difference, 17%; 95% confidence interval [CI], 8%-27%). Among the intervention group, 31 children (25%) were actively attending Head Start, contrasted with 14 (11%) in the control group (adjusted difference, 12%; 95% CI, 3%-21%). Only 2 clinics contributed children to Head Start waiting lists. Among children from these clinics, 19 of 87 (22%) in the intervention group got onto a Head Start waiting list, vs 8 of 94 (9%) in the control group (adjusted difference, 13%; 95% CI, 5%-21%). To get 1 child either into Head Start or onto a waiting list, we needed to refer 4 children.
Facilitating an initial connection to Head Start on families' behalf substantially increased Head Start attendance.
诸如“启智计划”之类的幼儿发展项目已被证明对贫困儿童有益。然而，很少有医生协助家庭进行入学登记。
测试基于初级保健的干预措施在提高“启智计划”入学率方面是否有效。
设计、地点和参与者：2003年春季从华盛顿州西雅图的4家健康诊所招募了246名符合“启智计划”条件的0至4岁儿童进行随机对照试验。
向所有儿童的家庭提供“启智计划”的电话联系方式清单，对于干预组的家庭，研究人员将一份包含医生推荐信（以及体检表和免疫记录，如有）的计算机生成的资料包直接邮寄给“启智计划”。
到2004年1月时“启智计划”的入学率。
每个研究组分析的123名儿童在基线时情况相似。总体而言，到2004年1月时，有72名儿童（29%）成功与“启智计划”建立联系（即积极入学或在等候名单上）。在干预组中，有50名儿童（41%）成功与“启智计划”建立联系，而对照组为22名（18%）（调整差异为17%；95%置信区间[CI]，8%-27%）。在干预组中，有31名儿童（25%）积极参加“启智计划”，而对照组为14名（11%）（调整差异为12%；95%CI，3%-21%）。只有2家诊所的儿童进入了“启智计划”等候名单。在这些诊所的儿童中，干预组87名中有19名（22%）进入了“启智计划”等候名单，而对照组94名中有8名（9%）（调整差异为13%；95%CI，5%-21%）。为使1名儿童进入“启智计划”或列入等候名单，我们需要推荐4名儿童。
代表家庭促成与“启智计划”的初步联系可大幅提高“启智计划”的入学率。
