Dietrich A J, Tobin J N, Sox C H, Cassels A N, Negron F, Younge R G, Demby N A, Tosteson T D
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA.
Arch Fam Med. 1998 Jul-Aug;7(4):320-7; discussion 328. doi: 10.1001/archfami.7.4.320.
Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations.
DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers.
Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review.
Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services.
Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.
实现癌症早期检测目标仍然是一项挑战，尤其是在低收入和少数族裔人群中。
设计/地点：一项基于纽约、新泽西和康涅狄格州西部62家为弱势群体服务的社区健康中心的随机试验。大多数中心都有家庭医生。
为中心负责人举办研讨会、提供资料并持续提供建议，以促进实施预防服务办公室系统，通过使用病历流程表、其他工具以及工作人员的参与，在每次就诊时识别需要服务的患者。
通过对基线（n = 2645）和随访（n = 2864）记录审查，按中心随机选择的患者中符合指定服务要求的比例。
只有一项服务（乳房自我检查建议）在干预中心增加得更多。8项目标服务中的7项在62个中心总体上显著增加。在研究期间，26个中心（42%）更换了医疗主任。在干预中心保留同一医疗主任与服务改善相关。
社区健康中心的癌症早期检测服务正在改善，但根据记录审查确定，干预措施的影响很小。要产生影响，干预措施要求医疗主任不发生变化。实践环境变化与所提供服务之间的关系很复杂，值得进一步研究。
