Williams R B, Boles M, Johnson R E
Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
Arch Fam Med. 1998 Jul-Aug;7(4):338-45. doi: 10.1001/archfami.7.4.338.
To test the effectiveness of a patient-initiated, touch-sensitive computer system (TSCS) for improving screening rates for cancers of the breast, cervix, colon and rectum, and oral cavity.
One-year, randomized, controlled trial with primary care practice as the unit of analysis.
Sixty primary care practices, randomly recruited from 329 nonteaching practices in a southeastern state.
Random sample of the medical records of 50 male and female adult patients before intervention and 50 adult patients after intervention in each practice and a random sample of 507 TSCS users.
Touch-sensitive computer system and a registered nurse who served as liaison to the study practices. The TSCS provided patient-specific preventive service recommendations and facilitated work flow to increase the completion of these interventions.
Average change, adjusted for health maintenance examination (HME) and use of the TSCS, in the proportion of eligible patients undergoing screening mammography, clinical breast examination, digital rectal examination, fecal occult blood test, flexible sigmoidoscopy, Papanicolaou smear, and oral cavity examination.
We observed a significant increase in the completion of screening mammography (6.6%; P < or = 0.5) and clinical breast examination (6.1%; P < or = .01) in women 50 years of age and older, particularly for those who had an HME during the study year.
Patients who have HMEs are more likely to receive cancer screening; however, a computer-based system for preventive services can contribute to improvement in screening. Among those patients who did not have an HME, TSCS users had higher rates of breast cancer screening than nonusers.
测试一种由患者启动的触摸感应计算机系统（TSCS）在提高乳腺癌、宫颈癌、结肠癌、直肠癌及口腔癌筛查率方面的有效性。
以初级保健机构为分析单位的为期一年的随机对照试验。
从东南部一个州的329家非教学机构中随机招募的60家初级保健机构。
每家机构干预前50名成年男女患者及干预后50名成年患者的医疗记录随机样本，以及507名TSCS用户的随机样本。
触摸感应计算机系统及一名担任研究机构联络人的注册护士。TSCS提供针对患者的预防服务建议并促进工作流程，以增加这些干预措施的完成率。
在接受乳房X线筛查、临床乳房检查、直肠指检、粪便潜血试验、乙状结肠镜检查、巴氏涂片检查及口腔检查的合格患者比例中，经健康维护检查（HME）和TSCS使用情况调整后的平均变化。
我们观察到，50岁及以上女性的乳房X线筛查（6.6%；P≤0.5）和临床乳房检查（6.1%；P≤0.01）完成率显著提高，尤其是在研究年度内接受过HME的女性。
接受HME的患者更有可能接受癌症筛查；然而，基于计算机的预防服务系统有助于提高筛查率。在未接受HME的患者中，TSCS用户的乳腺癌筛查率高于非用户。
