Zenni E A, Robinson T N
Department of Pediatrics, Stanford University School of Medicine, Calif, USA.
Arch Pediatr Adolesc Med. 1996 Sep;150(9):975-80. doi: 10.1001/archpedi.1996.02170340089017.
To evaluate the effects of health supervision structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care.
Randomized, controlled trial.
Pediatric house staff continuity clinic in a university-based children's hospital.
53 pediatric house officers and 153 parents.
House staff were randomized to use structured encounter forms focused on developmental milestones (group 1) or anticipatory guidance/preventive care (group 2) during health supervision visits.
Changes in house staff knowledge were assessed with pretests and posttests. Parent satisfaction was assessed with surveys. Quality of care, defined as compliance with recommended guidelines for age-specific health supervision, was assessed by audiotaping visits.
Group 1 demonstrated greater but not significantly different improvement in knowledge of developmental milestones than group 2, while group 2 improved more than group 1 in knowledge of anticipatory guidance/ preventive care. Parent satisfaction with developmental screening was significantly greater for group 1 visits than for group 2 visits (P < .001). Group 1 demonstrated significantly greater compliance than group 2 with recommended standards of developmental screening (P = .001).
The use of structured encounter forms for health supervision in pediatric house staff continuity clinics may increase house staff knowledge of developmental milestones and anticipatory guidance/preventive care, increases parent satisfaction with developmental assessment during health supervision, and improves compliance with recommended guidelines for developmental assessment.
评估健康监督结构化问诊表对儿科住院医师知识水平、家长满意度及护理质量的影响。
随机对照试验。
一所大学附属医院的儿科住院医师连续性门诊。
53名儿科住院医师和153名家长。
住院医师被随机分为两组，在健康监督访视期间，一组使用聚焦于发育里程碑的结构化问诊表（第1组），另一组使用预期指导/预防保健相关的结构化问诊表（第2组）。
通过预测试和后测试评估住院医师知识水平的变化。通过调查问卷评估家长满意度。通过对访视进行录音来评估护理质量，护理质量定义为符合针对特定年龄健康监督的推荐指南情况。
第1组在发育里程碑知识方面的改善比第2组更大，但差异无统计学意义，而第2组在预期指导/预防保健知识方面的改善比第1组更大。第1组访视时家长对发育筛查的满意度显著高于第2组访视（P <.001）。第1组在发育筛查推荐标准的依从性方面显著高于第2组（P =.001）。
在儿科住院医师连续性门诊中使用结构化问诊表进行健康监督，可能会提高住院医师对发育里程碑和预期指导/预防保健的知识水平，提高家长对健康监督期间发育评估的满意度，并改善对发育评估推荐指南的依从性。
