Christakis Dimitri A, Zimmerman Frederick J, Rivara Frederick P, Ebel Beth
Department of Pediatrics, University of Washington, Seattle, Washington 98115, USA.
Pediatrics. 2006 Sep;118(3):1157-66. doi: 10.1542/peds.2006-0209.
Innovations to improve the delivery of pediatric preventive care are needed.
We enrolled children, 0 to 11 years of age, into a factorial, randomized, controlled trial of a tailored, evidence-based, Web site (MyHealthyChild) that provided information on prevention topics before a scheduled well-child visit. There were 2 components of the intervention, namely, parental Web content and provider notification. Parental Web content provided information to parents about prevention topics; provider notification communicated to physicians topics that were of interest to parents. We assigned 887 children randomly to 4 groups (usual care, content only, content and notification, or notification only). Outcomes were determined with telephone follow-up surveys conducted 2 to 4 weeks after the visit. Poisson regression analysis was used to determine the independent effects of each intervention on the number of topics discussed and the number of preventive practices implemented.
Parents in the notification/content group and in the notification-only group reported discussing more MyHealthyChild topics with their provider. Parents in the notification/content group and in the content-only group reported implementing more MyHealthyChild topic suggestions (such as use of a safety device).
A Web-based intervention can activate parents to discuss prevention topics with their child's provider. Delivery of tailored content can promote preventive practices.
需要创新措施来改善儿科预防保健服务的提供。
我们将0至11岁的儿童纳入一项析因随机对照试验，该试验涉及一个量身定制的、基于证据的网站（MyHealthyChild），该网站在预定的儿童健康检查前提供预防主题信息。干预措施有两个组成部分，即家长网络内容和向医疗服务提供者发送通知。家长网络内容向家长提供有关预防主题的信息；向医疗服务提供者发送通知则将家长感兴趣的主题传达给医生。我们将887名儿童随机分为4组（常规护理组、仅提供内容组、提供内容并发送通知组或仅发送通知组）。在就诊后2至4周通过电话随访调查确定结果。采用泊松回归分析来确定每种干预措施对讨论的主题数量和实施的预防措施数量的独立影响。
在提供通知/内容组和仅发送通知组中的家长报告称，他们与医疗服务提供者讨论的MyHealthyChild主题更多。在提供通知/内容组和仅提供内容组中的家长报告称，他们实施的MyHealthyChild主题建议（如使用安全设备）更多。
基于网络的干预措施可以促使家长与孩子的医疗服务提供者讨论预防主题。提供量身定制的内容可以促进预防措施的实施。
