Hung Dorothy Y, Rundall Thomas G, Crabtree Benjamin F, Tallia Alfred F, Cohen Deborah J, Halpin Helen A
Division of Health Policy and Management, School of Public Health, University of California-Berkeley, USA.
Am J Prev Med. 2006 May;30(5):413-22. doi: 10.1016/j.amepre.2005.12.012.
While visits to the doctor's office are appropriate times to advise patients on health behaviors, these opportunities are often missed. Lapses in care quality are no longer attributed solely to individuals, but are also increasingly understood to be the result of organizational factors. This research examines the influence that both practice and provider attributes have on the delivery of preventive services for health behaviors.
This study used data collected from the Prescription for Health initiative sponsored by the Robert Wood Johnson Foundation. Quantitative data on 52 primary care practices and 318 healthcare providers were gathered from September 2003 to September 2004, and were analyzed upon completion of data collection. Hierarchical linear modeling was used to examine associations between both practice and provider attributes and preventive service delivery.
Practice staff participation in decisions regarding quality improvement, practice change, and clinical operations positively influenced the effect of work relationships and negatively influenced the effect of practice size on service delivery. Nurse practitioners and allied health professionals reported more frequent delivery of services compared to physicians. Last, use of reminder systems and patient registries were positively associated with preventive service delivery.
This study offers preliminary support for staff participation in practice decisions as a positive aspect of teamwork and collaboration. Findings also suggest leveraging nonphysician clinical staff and organized clinical systems to improve the delivery of preventive services for health behaviors.
虽然去医生办公室就诊是就健康行为向患者提供建议的合适时机，但这些机会常常被错过。护理质量的下滑不再仅仅归因于个人，人们也越来越认识到这是组织因素导致的结果。本研究考察了诊所及医疗服务提供者的属性对健康行为预防服务提供情况的影响。
本研究使用了从罗伯特·伍德·约翰逊基金会发起的“健康处方”倡议中收集的数据。2003年9月至2004年9月收集了52个初级保健诊所和318名医疗服务提供者的定量数据，并在数据收集完成后进行了分析。采用分层线性模型来考察诊所及医疗服务提供者的属性与预防服务提供之间的关联。
诊所工作人员参与质量改进、诊所变革及临床运营方面的决策，对工作关系的效果有积极影响，而对诊所规模对服务提供的影响有消极影响。与医生相比，执业护士和专职医疗专业人员报告的服务提供频率更高。最后，提醒系统和患者登记册的使用与预防服务提供呈正相关。
本研究为工作人员参与诊所决策作为团队合作和协作的积极方面提供了初步支持。研究结果还表明，利用非医生临床工作人员和有组织的临床系统来改善健康行为预防服务的提供。
