Houston Thomas K, Wall Terry, Allison Jeroan J, Palonen Katri, Willett Lisa L, Keife Catarina I, Massie F Stanford, Benton E Cason, Heudebert Gustavo R
Division of General Internal Medicine, University of Alabama at Birmingham School of Medicine, 35294, USA.
Acad Med. 2006 Jul;81(7):608-16. doi: 10.1097/01.ACM.0000232410.97399.8f.
To evaluate the Preventive Health Achievable Benchmarks Curriculum, a multifaceted improvement intervention that included an objective, practice-based performance evaluation of internal medicine and pediatric residents' delivery of preventive services.
The authors conducted a nonrandomized experiment of intervention versus control group residents with baseline and follow-up of performance audited for 2001-2004. All 130 internal medicine and 78 pediatric residents at two continuity clinics at the University of Alabama School of Medicine, Birmingham, participated. Performance of preventive care was assessed by structured chart review. The multifaceted feedback curriculum included individualized performance feedback, academic detailing by faculty, and collective didactic sessions. The main outcome was difference in receipt of preventive care for patients seen by intervention and control residents, comparing baseline and follow-up.
Charts were reviewed for 3,958 patients. Receipt of preventive care increased for patients of intervention residents, but not for patients of control residents. For the intervention group, significant increases occurred for five of six indicators in internal medicine: smoking screening, quit smoking advice, colon cancer screening, pneumonia vaccine, and lipid screening; and four of six in pediatrics: parental quit smoking advice, car seats, car restraints, and eye alignment (p < .05 for all). For control residents, no consistent improvements were seen. There was greater improvement for intervention than for control residents for four of six indicators in internal medicine, and two of six in pediatrics.
Using a multifaceted feedback curriculum, the authors taught residents about the care they provide and improved documented patient care.
评估“可实现的预防保健基准课程”，这是一项多方面的改进干预措施，其中包括对内科和儿科住院医师提供预防服务的情况进行基于实践的客观绩效评估。
作者对干预组和对照组的住院医师进行了一项非随机实验，对2001 - 2004年的绩效进行了基线和随访审核。阿拉巴马大学医学院伯明翰分校两家连续性诊所的所有130名内科住院医师和78名儿科住院医师参与了研究。通过结构化图表审查评估预防保健的绩效。多方面的反馈课程包括个性化绩效反馈、教员的学术指导以及集体授课。主要结果是比较干预组和对照组住院医师所诊治患者在基线和随访时接受预防保健情况的差异。
共审查了3958名患者的图表。干预组住院医师诊治的患者接受预防保健的情况有所增加，而对照组住院医师诊治的患者则没有。对于干预组，内科六项指标中的五项有显著增加：吸烟筛查、戒烟建议、结肠癌筛查、肺炎疫苗接种和血脂筛查；儿科六项指标中的四项有显著增加：父母戒烟建议、汽车座椅、汽车安全带和视力检查（所有p值均<0.05）。对于对照组住院医师，未观察到持续的改善。内科六项指标中的四项以及儿科六项指标中的两项，干预组住院医师的改善情况优于对照组住院医师。
通过使用多方面的反馈课程，作者向住院医师传授了他们所提供的护理知识，并改善了有记录的患者护理情况。
