在医疗服务短缺人群中采用信息技术减少哮喘治疗差异：初步研究
2010/11/04
摘要
背景：较低的健康素养被认为是哮喘控制较差的一个独立预测因素。医学研究所认为，信息技术（IT）是提供安全、有效、以患者为中心、及时、高效、公平医疗服务的重要手段，能减少医疗服务短缺人群的健康差异。本试验为设计和评价一项旨在评价儿童哮喘症状、基于电脑的交互式问卷调查，这些儿童的父母健康素养和/或英语水平有限。
方法：参加哮喘移动门诊的看护者随机分组，完成电子版或纸质版的哮喘筛查问卷调查（ASQ），语言类别自己选择（英语或西班牙语）。电子版调查中，台式电脑播放ASQ问题的视屏剪辑，通过触摸屏收集信息。参与者同时完成人口统计学问卷、简要健康素养问卷、系统实用性和满意度调查。通过比较每位参与者的回答与其在护士引导下结构化面试（金标准）中提供的信息，评价纸质版和电子版自我评估的可靠性。
结果：共48名父母参与本项研究，26名完成电子版ASQ，21名完成纸质版ASQ。35%的儿童哮喘控制较好 （n = 17）。大部分参与者采用西班牙语（67%；n = 44），其中母亲43人，平均年龄为32岁。一半以上的父母受教育年限不超过8年（n=25），每年收入小于2万美元（n=27）。平均健康素养评分为32（0~36）。健康素养评分与受教育年限存在显著相关性（ρ =0 .47, p <0.01）。电子版ASQ和护士访谈中的一致性要高于纸质版ASQ与访谈的一致性（分别为68%何54%；p <0.01）。所有完成电子版ASQ的父母主诉满意，96%的父母对该调查的使用感到满意，而且认为使用简单。
结论：在适当费用内，增加对哮喘症状的评价，交互式信息技术工具有助于减少因英语水平和健康素养低造成的哮喘评价障碍。
（苏楠 审校）
J Asthma. 2010 Sep 17. [Epub ahead of print]
Using Information Technology to Reduce Asthma Disparities in Underserved Populations: A Pilot Study.
Vargas PA, Robles E, Harris J, Radford P.
Department of Social and Behavioral Sciences, Arizona State University, Glendale, Arizona, U.S.A.
Abstract
Background. Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing "safe, effective, patient centered, timely, efficient, and equitable" care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency.
Methods. Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant’s answers to information they provided during a nurse-guided structured interview (gold standard).
Results. A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned <$20,000 per year (n = 27). The median health literacy score was 32 (range 0-36). The correlation between health literacy scores and years of education was significant (ρ = .47, p < .01). Concordance between the electronic ASQ and the nurse interview was significantly higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p < .01). All parents who completed the electronic questionnaire reported being satisfied; 96% felt comfortable using it, and found it simple to use.
Conclusions. By facilitating the assessment of asthma symptoms at manageable cost, interactive information technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.
J Asthma. 2010 Sep 17. [Epub ahead of print]
背景：较低的健康素养被认为是哮喘控制较差的一个独立预测因素。医学研究所认为，信息技术（IT）是提供安全、有效、以患者为中心、及时、高效、公平医疗服务的重要手段，能减少医疗服务短缺人群的健康差异。本试验为设计和评价一项旨在评价儿童哮喘症状、基于电脑的交互式问卷调查，这些儿童的父母健康素养和/或英语水平有限。
方法：参加哮喘移动门诊的看护者随机分组，完成电子版或纸质版的哮喘筛查问卷调查（ASQ），语言类别自己选择（英语或西班牙语）。电子版调查中，台式电脑播放ASQ问题的视屏剪辑，通过触摸屏收集信息。参与者同时完成人口统计学问卷、简要健康素养问卷、系统实用性和满意度调查。通过比较每位参与者的回答与其在护士引导下结构化面试（金标准）中提供的信息，评价纸质版和电子版自我评估的可靠性。
结果：共48名父母参与本项研究，26名完成电子版ASQ，21名完成纸质版ASQ。35%的儿童哮喘控制较好 （n = 17）。大部分参与者采用西班牙语（67%；n = 44），其中母亲43人，平均年龄为32岁。一半以上的父母受教育年限不超过8年（n=25），每年收入小于2万美元（n=27）。平均健康素养评分为32（0~36）。健康素养评分与受教育年限存在显著相关性（ρ =0 .47, p <0.01）。电子版ASQ和护士访谈中的一致性要高于纸质版ASQ与访谈的一致性（分别为68%何54%；p <0.01）。所有完成电子版ASQ的父母主诉满意，96%的父母对该调查的使用感到满意，而且认为使用简单。
结论：在适当费用内，增加对哮喘症状的评价，交互式信息技术工具有助于减少因英语水平和健康素养低造成的哮喘评价障碍。
（苏楠 审校）
J Asthma. 2010 Sep 17. [Epub ahead of print]
Using Information Technology to Reduce Asthma Disparities in Underserved Populations: A Pilot Study.
Vargas PA, Robles E, Harris J, Radford P.
Department of Social and Behavioral Sciences, Arizona State University, Glendale, Arizona, U.S.A.
Abstract
Background. Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing "safe, effective, patient centered, timely, efficient, and equitable" care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency.
Methods. Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant’s answers to information they provided during a nurse-guided structured interview (gold standard).
Results. A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned <$20,000 per year (n = 27). The median health literacy score was 32 (range 0-36). The correlation between health literacy scores and years of education was significant (ρ = .47, p < .01). Concordance between the electronic ASQ and the nurse interview was significantly higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p < .01). All parents who completed the electronic questionnaire reported being satisfied; 96% felt comfortable using it, and found it simple to use.
Conclusions. By facilitating the assessment of asthma symptoms at manageable cost, interactive information technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.
J Asthma. 2010 Sep 17. [Epub ahead of print]
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在哮喘患儿中，医疗之家的质量与校内外活动间的关系
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清除临床障碍：采用患者导向来增加哮喘治疗的社会支持
