Battista R N, Williams J I, Boucher J, Rosenberg E, Stachenko S J, Adam J, Levinton C, Suissa S
Department of Epidemiology, McGill University, Montreal, Que.
CMAJ. 1991 Jun 1;144(11):1469-74.
To test three methods of introducing health charts into the medical records of six family medicine units.
Quasi-experiment.
The staff physicians and family medicine residents in all six units and the nurses in two units.
Group 1 (minimal intervention): health charts, a user's guide and one training session. Group 2 (intermediate intervention): same intervention as for group 1 plus two feedback sessions at 3 and 6 months. Group 3 (maximum intervention): same intervention as for group 2 plus promotion of the team concept (nurses were included). The intervention phase lasted from September 1987 to August 1988.
The frequency with which the health charts were used, the item scores of each preventive care activity and the overall unit scores. Data were gathered through chart audits at baseline and at the end of the intervention phase.
The frequency with which the health charts were used varied from 3.9% to 26.9%. The greatest increases in item scores were observed in the use of mammography (20.0%), counselling on lifestyle (19.4%) and breast examination (17.2%). Although the overall improvement in the unit scores was statistically significant (p less than 0.05) the hypothesis of an increasing gradient of effect across the three intervention groups could not be tested because of the variation in scores across the units.
Health charts and other similar tools are useful; however, they are not sufficient to change practice behaviours. The support of a "champion" on the health care team might well be a determining factor of success for the delivery of preventive services in primary care practice.
测试将健康图表引入六个家庭医疗单位病历的三种方法。
准实验。
所有六个单位的执业医师和家庭医学住院医师以及两个单位的护士。
第1组（最小干预）：健康图表、用户指南和一次培训课程。第2组（中等干预）：与第1组相同的干预措施，外加在3个月和6个月时进行两次反馈会议。第3组（最大干预）：与第2组相同的干预措施，外加团队概念推广（纳入护士）。干预阶段从1987年9月持续到1988年8月。
健康图表的使用频率、每项预防保健活动的项目得分以及单位总体得分。通过在基线和干预阶段结束时的病历审核收集数据。
健康图表的使用频率从3.9%到26.9%不等。在乳房X光检查（20.0%）、生活方式咨询（19.4%）和乳房检查（17.2%）的使用中观察到项目得分的最大增幅。尽管单位得分的总体改善具有统计学意义（p小于0.05），但由于各单位得分存在差异，无法检验三个干预组效果递增梯度的假设。
健康图表和其他类似工具是有用的；然而，它们不足以改变实践行为。医疗团队中“倡导者”的支持很可能是基层医疗实践中提供预防服务取得成功的决定性因素。
