RESUMEN
This quality improvement project was designed to improve rates of referral for colonoscopy screening in the Utah Health Research Network, University of Utah Community Clinics. This study was conducted between October 2004 and June 2007 with the main intervention being a clinic workflow modification using computerized screening reminders embedded in the electronic medical record (EMR). The intervention led to sustained improvement, largely driven by the performance of two network clinics. This study demonstrates that a robust EMR, with decision prompts, accompanied by clinic workflow changes and feedback to providers, can lead to sustained change in the rates of colonoscopy referral.
Asunto(s)
Colonoscopía , Registros Electrónicos de Salud , Atención Primaria de Salud/métodos , Derivación y Consulta/estadística & datos numéricos , Sistemas Recordatorios , Humanos , Garantía de la Calidad de Atención de Salud , Derivación y Consulta/tendenciasRESUMEN
OBJECTIVES: We examined the associations of residential segregation with poor birth outcomes (low birthweight, preterm) and with perinatal risk markers (maternal age, education and marital status, prenatal care and substance use, presence of paternal information on birth certificate) for foreign- and native-born black women in the Minnesota seven-county metropolitan area. METHODS: Data were from 1990-1999 Minnesota birth certificates linked to the 1990 U.S. census. We used multivariable logistic regression to examine the association of perinatal risk markers, low birthweight and preterm birth for foreign- and native-born black women by residential black concentration. RESULTS: Native-born black women had a higher prevalence of risk markers and were at almost 1.5 times the risk of foreign-born blacks for delivery of low-birthweight or preterm infants. Risk markers and poor birth outcomes were most prevalent in medium and high-black-concentration areas than low-concentration areas. Preterm birth was slightly positively associated with residential black concentration. CONCLUSIONS: Native-born black women were at higher risk than foreign-born women for delivery of preterm and low-birthweight infants. Residential black concentration was associated with risk markers and only slightly associated with preterm birth. Further study of why birth outcome differentials exist by nativity and residential black concentration may identify opportunities for community-based public health interventions.