基于计算机的预防服务系统的实施与评估。

Implementation and evaluation of a computer-based preventive services system.

作者信息

Ornstein S M, Garr D R, Jenkins R G, Musham C, Hamadeh G, Lancaster C

机构信息

Department of Family Medicine, Medical University of South Carolina, Charleston, USA.

出版信息

Fam Med. 1995 Apr;27(4):260-6.

PMID:7797005

Abstract

BACKGROUND AND OBJECTIVES

Insufficient attention has been paid to the role that modern information systems can play in improving the delivery of and education about preventive services in family medicine training and practice sites. From September 1990-September 1993, the Department of Family Medicine at the Medical University of South Carolina conducted a demonstration project designed to develop, implement, and evaluate a comprehensive, computer-based preventive services delivery and educational system, based on the recommendations in the US Preventive Services Task Force (USPSTF) Report.

METHODS

A computer-based patient record (CPR) system was implemented. The system had sophisticated preventive services tracking and reminder, physician, and patient education features. Twenty-nine basic USPSTF recommendations were incorporated in the system. An extensive physician education series was also implemented. A multi-method evaluation system, including patient exit surveys, physician interviews, and practice audits was used to evaluate and design improvements to the CPR and education systems.

RESULTS

Although the system initially had no effect on patient perceptions about the frequency of preventive services delivery, there was reasonable concordance between patient desires and physician behavior for the discussion of preventive services (Kappa = .5 to .6). Physician acceptance of the system was good--in 1992, 30% of physicians used the preventive services reminders in most of their patient visits, and in 1993, 88% of physicians reported more frequent use. Practice audits from February 1992-July 1993 showed increased adherence with all seven counseling services, 10 of 15 screening services, and one of five immunization services.

CONCLUSIONS

A CPR-based preventive services system coupled with an adaptable physician education about and delivery of preventive services. an ideal solution to improving the education about and delivery of preventive services.

摘要

背景与目的

现代信息系统在改善家庭医学培训及实践场所的预防服务提供与教育方面所能发挥的作用，尚未得到充分关注。1990年9月至1993年9月，南卡罗来纳医科大学家庭医学系开展了一个示范项目，旨在根据美国预防服务工作组（USPSTF）报告中的建议，开发、实施并评估一个基于计算机的综合性预防服务提供与教育系统。

方法

实施了一个基于计算机的患者记录（CPR）系统。该系统具备完善的预防服务跟踪与提醒、医师及患者教育功能。系统纳入了29条USPSTF的基本建议。还开展了一系列广泛的医师教育活动。采用了包括患者出院调查、医师访谈及实践审核在内的多方法评估系统，以评估并设计对CPR及教育系统的改进。

结果

尽管该系统最初对患者对预防服务提供频率的认知没有影响，但在预防服务讨论方面，患者意愿与医师行为之间存在合理的一致性（Kappa系数=0.5至0.6）。医师对该系统的接受度良好——1992年，30%的医师在大多数患者就诊时使用了预防服务提醒，1993年，88%的医师报告使用频率更高。1992年2月至1993年7月的实践审核显示，所有七项咨询服务、15项筛查服务中的10项以及五项免疫服务中的一项的依从性有所提高。