基于初级保健信息学的乳腺癌筛查系统的整群随机试验。
A cluster-randomized trial of a primary care informatics-based system for breast cancer screening.
机构信息
General Medicine Division, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston, MA 02114, USA.
出版信息
J Gen Intern Med. 2011 Feb;26(2):154-61. doi: 10.1007/s11606-010-1500-0. Epub 2010 Sep 15.
BACKGROUND
Information technology offers the promise, as yet unfulfilled, of delivering efficient, evidence-based health care.
OBJECTIVE
To evaluate whether a primary care network-based informatics intervention can improve breast cancer screening rates.
DESIGN
Cluster-randomized controlled trial of 12 primary care practices conducted from March 20, 2007 to March 19, 2008.
PATIENTS
Women 42-69 years old with no record of a mammogram in the prior 2 years.
INTERVENTIONS
In intervention practices, a population-based informatics system was implemented that: connected overdue patients to appropriate care providers, presented providers with a Web-based list of their overdue patients in a non-visit-based setting, and enabled "one-click" mammography ordering or documented deferral reasons. Patients selected for mammography received automatically generated letters and follow-up phone calls. All practices had electronic health record reminders about breast cancer screening available during clinical encounters.
MAIN MEASURES
The primary outcome was the proportion of overdue women undergoing mammography at 1-year follow-up.
KEY RESULTS
Baseline mammography rates in intervention and control practices did not differ (79.5% vs 79.3%, p = 0.73). Among 3,054 women in intervention practices and 3,676 women in control practices overdue for mammograms, intervention patients were somewhat younger, more likely to be non-Hispanic white, and have health insurance. Most intervention providers used the system (65 of 70 providers, 92.9%). Action was taken for 2,652 (86.8%) intervention patients [2,274 (74.5%) contacted and 378 (12.4%) deferred]. After 1 year, mammography rates were significantly higher in the intervention arm (31.4% vs 23.3% in control arm, p < 0.001 after adjustment for baseline differences; 8.1% absolute difference, 95% CI 5.1-11.2%). All demographic subgroups benefited from the intervention. Intervention patients completed screening sooner than control patients (p < 0.001).
CONCLUSIONS
A novel population-based informatics system functioning as part of a non-visit-based care model increased mammography screening rates in intervention practices.
TRIAL REGISTRATION
ClinicalTrials.gov; NCT00462891.
背景
信息技术有望提供高效、基于证据的医疗服务，但目前尚未实现这一承诺。
目的
评估基于初级保健网络的信息学干预是否可以提高乳腺癌筛查率。
设计
2007 年 3 月 20 日至 2008 年 3 月 19 日期间，对 12 个初级保健实践进行了以群组为基础的随机对照试验。
患者
年龄在 42-69 岁之间，且在过去 2 年内没有进行过乳房 X 光检查的女性。
干预措施
在干预实践中，实施了基于人群的信息系统，该系统：将逾期患者与合适的护理提供者联系起来，在非就诊环境下为提供者提供一份逾期患者的基于网络的清单，并允许“一键式”乳房 X 光检查订单或记录延期原因。选择进行乳房 X 光检查的患者会收到自动生成的信件和后续电话。所有实践都在临床就诊期间提供关于乳腺癌筛查的电子健康记录提醒。
主要结果
主要结果是在 1 年随访时进行乳房 X 光检查的逾期女性比例。
关键结果
干预和对照实践中的基线乳房 X 光检查率没有差异（79.5%对 79.3%，p=0.73）。在干预实践中，有 3054 名逾期行乳房 X 光检查的女性和在对照实践中，有 3676 名逾期行乳房 X 光检查的女性中，干预患者年龄稍小，更有可能是非西班牙裔白人，并且有医疗保险。大多数干预提供者都使用了该系统（70 名提供者中的 65 名，92.9%）。对 2652 名（86.8%）干预患者采取了行动[2274 名（74.5%）联系，378 名（12.4%）延期]。1 年后，干预组的乳房 X 光检查率显著高于对照组（31.4%对 23.3%，调整基线差异后 p<0.001；8.1%的绝对差异，95%CI 5.1-11.2%）。所有人口统计学亚组都从干预中受益。干预患者比对照患者更早完成筛查（p<0.001）。
结论
一种新的基于人群的信息学系统，作为非就诊式护理模式的一部分，提高了干预实践中的乳房 X 光检查率。
试验注册
ClinicalTrials.gov；NCT00462891。
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