Bingham R L, Plante D A, Bronson D L, Tufo H M, McKnight K
Department of Psychiatry, University of Vermont, Burlington.
J Gen Intern Med. 1990 Jul-Aug;5(4):342-6. doi: 10.1007/BF02600403.
A quality improvement process that will significantly increase the rate of identification of psychosocial problems through routine use of case-finding instruments can be established in a general medicine practice.
Two groups of patient examination reports written by physicians were retrospectively compared with the patients' responses on the case-finding database instrument. The samples were obtained by sequential selection in four time periods.
The study occurred in a university general internal medicine practice that utilizes the problem-oriented record. The patients studied were seen for first-time comprehensive examinations designed to identify all important health problems, including psychosocial problems.
The authors compared performances of the physicians in identification of psychosocial problems before and after the intervention, which consisted of a pilot study audit of psychosocial problem identification, establishment of standards for interpretation of the case-finding instrument, design of a flow sheet to make case-finding data clearly available to the physician at each comprehensive examination, and feedback of physician performance according to practice-adopted standards for identification of psychosocial problems.
The result of the intervention was an increase in psychosocial problem identification from 67% to 90% of problems present, p less than 0.05 by chi-square distribution; or a decrease from 33% to 10% in psychosocial problems missed by the physicians.
The quality improvement process for identification of psychosocial problems described in this report significantly increased the rate of identification of psychosocial problems by general internists.
在普通内科实践中，可以建立一种质量改进流程，通过常规使用病例发现工具显著提高心理社会问题的识别率。
回顾性比较两组由医生撰写的患者检查报告与患者在病例发现数据库工具上的回答。样本是在四个时间段内按顺序选取的。
该研究在一所采用问题导向记录的大学普通内科实践中进行。所研究的患者接受首次全面检查，旨在识别所有重要的健康问题，包括心理社会问题。
作者比较了干预前后医生在识别心理社会问题方面的表现，干预措施包括对心理社会问题识别进行试点研究审核、制定病例发现工具的解释标准、设计流程图以便在每次全面检查时让医生清楚获得病例发现数据，以及根据实践采用的心理社会问题识别标准反馈医生的表现。
干预结果是心理社会问题的识别率从存在问题的67%提高到90%，经卡方分布检验，p<0.05；或者医生遗漏的心理社会问题从33%降至10%。
本报告中描述的心理社会问题识别质量改进流程显著提高了普通内科医生对心理社会问题的识别率。
