Hollister Dickerman, Romanello Joseph M, Smith Meryl L, Radford Martha J
Department of Medicine, Greenwich Hospital and The Yale New Haven Health System, USA.
Conn Med. 2006 Nov-Dec;70(10):613-20.
The benefits of preventive and screening health-care measures have been well documented, but physician compliance with these measures has been imperfect. This investigation sought to measure and improve compliance of seven internists with a range of health-care measures.
This study had two parts. Part 1: Office medical records of seven internists were scored on 36 measures. Physicians were given their individual and group scores to determine if such data would improve future compliance with these measures. A second record review was performed six months later, and the two compliance scores for both individual physician and the group were compared. Part 2: A flow sheet utilizing these 36 measures was custom designed for each physician to determine if this tool would increase compliance rates over those determined in Part 1.
Part 1: Baseline compliance with health measures by these internists was approximately 75%. Providing individual and group scores to physicians had no significant effect on compliance with these health-care measures as measured by the second record review. Part 2: Custom designed flow sheets provided comparable compliance rates and were as effective as record review in assessing compliance, with some measures improving and some declining in comparison scores on Part 1. The flow sheet itself, however, did not increase overall compliance scores either for individual physicians or the group as a whole.
Baseline compliance with health-care measures was higher in this investigation than reported elsewhere. Neither data feedback nor redesigned flow sheets increased overall compliance rates, but flow sheets were superior in documenting some frequently updated items, such as medication lists. Flow sheets were inexpensive and easy to implement. Additionally, flow sheets allowed for more rapid assessment of physician performance than time-consuming chart review. Until superior methods are widely available, the use of flow sheets in ambulatory care should be encouraged.
预防性和筛查性医疗保健措施的益处已有充分记录，但医生对这些措施的依从性并不理想。本研究旨在衡量并提高七位内科医生对一系列医疗保健措施的依从性。
本研究分为两个部分。第一部分：根据36项措施对七位内科医生的门诊病历进行评分。向医生提供他们的个人和小组评分，以确定此类数据是否会提高未来对这些措施的依从性。六个月后进行第二次病历审查，并比较每位医生和小组的两次依从性评分。第二部分：为每位医生定制设计了一份使用这36项措施的流程图，以确定该工具是否会比第一部分确定的依从率有所提高。
第一部分：这些内科医生对健康措施的基线依从率约为75%。根据第二次病历审查，向医生提供个人和小组评分对这些医疗保健措施的依从性没有显著影响。第二部分：定制设计的流程图提供了可比的依从率，并且在评估依从性方面与病历审查同样有效，与第一部分相比，一些措施有所改善，一些措施有所下降。然而，流程图本身并未提高个别医生或整个小组的总体依从性评分。
在本研究中，对医疗保健措施的基线依从率高于其他地方报告的水平。数据反馈和重新设计的流程图均未提高总体依从率，但流程图在记录一些经常更新的项目（如药物清单）方面更具优势。流程图成本低廉且易于实施。此外，与耗时的图表审查相比，流程图能够更快地评估医生的表现。在更优方法广泛可用之前，应鼓励在门诊护理中使用流程图。
Zotero 插件