A b s t r a c t Objective:To understand and address patients' need for information surrounding ambulatory-care visits. Design:The authors conducted two patient focus groups regarding patient education. The first covered general information needs of patients and the second explored their reactions to a computer-generated patient handout that was developed in response to the results of the first focus group and implemented in a clinic. Results:Participants sought information about their health -generally after the encounter with their caregiver. They wanted a permanent record of personal health data and relevant educational information. Participants recommended that the information be concise, clear, and illustrated with graphics if appropriate. Receiving health-related information from their providers favorably affected the participants' trust in, relationship with, and confidence in their physicians. When given printouts with graphic trends depicting their responses to therapy, participants reported that they were more motivated to adhere to a treatment plan and were more satisfied with their care. Based on the results of the focus groups, we developed a set of attributes (P.A.T.I.E.N.T.) to guide the development of patient and consumer health information. Conclusions:Patients participating in our focus groups felt that providing printed summary information to patients at the end of a clinic visit improves their understanding of their care, enhances their relationships with providers, improves their satisfaction with care, and motivates them to adhere to treatment plans. Further empirical studies are necessary to test their perceptions.Ⅲ J Am Med Inform Assoc. 1998;5:563 -570.In general, patients want to participate more in decisions regarding their health and health care.1 -4 Although the exact role that a patient wishes to play in decision making will vary from patient to patient, the desire for information about care is high. 5 -7 We are interested in developing, as part of a computer-based patient record system project, tools that assist caregivers in providing better health information to their patients. In this paper, we describe results of two patient focus groups regarding patients' information needs. We previously reported the results of a focus group that covered the broad topic of patient information needs following an ambulatory-care visit. 5 We conducted a second focus group to explore patients' reaction to a document (the after-visit summary) designed to meet the information needs identified by the first group. We believe that addressing patients' need for information will allow them to more effectively participate in their own care.

To evaluate the influence of computer-based reminders about influenza vaccination on the behavior of individual clinicians at each clinical opportunity. Design:The authors conducted a prospective study of clinicians' influenza vaccination behavior over four years. Approximately one half of the clinicians in an internal medicine clinic used a computer-based patient record system (CPR users) that generated computer-based reminders. The other clinicians used traditional paper records (PR users).Measurements: Each nonacute visit by a patient eligible for an influenza vaccination was considered an opportunity for intervention. Patients who had contraindications for vaccination were excluded. Compliance with the guideline was defined as documentation that a clinician ordered the vaccine, counseled the patient about the vaccine, offered the vaccine to a patient who declined it, or verified that the patient had received the vaccine elsewhere. The authors calculated the proportion of opportunities on which each clinician documented action in the CPR and PR user groups. Results:The CPR and PR user groups had different baseline compliance rates (40.1 and 27.9 per cent, respectively; P < 0.05). Both rates remained stable during a two-year baseline period (P = 0.34 and P = 0.47, respectively). The compliance rates in the CPR user group increased 78 per cent from baseline (P < 0.001), whereas the rates for the PR user group did not change significantly (P = 0.18). Conclusions:Clinicians who used a CPR with reminders had higher rates of documentation of compliance with influenza-vaccination guidelines than did those who used a paper record. Measurements of individual clinician behavior at the point of each clinical opportunity can provide precise evaluation of interventions that are designed to improve compliance with guidelines.

The favorable results of the minimal stimulation program here described have important implications for all who provide health services for underprivileged preschool children. The authors indicate that this project is the first which coordinates compensatory infant education with complete health care, with the prime educator being a public health nurse.T&dquo; many inner city children do poorly I 'HAT many inner cit children do poorly in our public school systems is undisputed. As a group they show IQ scores 10 to 20 points below middle class children,, and have more behavior disturbances and personality dysfunctions in school. 2. One of the earliest and broadest attempts at enrichment, the Head Start program, seems to have established two far-reaching principles: (I) three years of age is much too late to begin intervention,~ (2) unless the educational program includes the parents the results will be meager and reversible .4As a direct result of the deficiencies revealed through the Head Start experience, 36 Parent and Child Centers were started in 1967 with programs directed toward improving the physical and emotional health and cognitive development of children from birth to 3 years of age.&dquo; The Centers, administered by the Office of Economic Opportunity, may encompass both homebased stimulation efforts and day care programs. These long-term and expensive studies are being evaluated, but statistical data will not be available for some time. The same may be said for the handful of experimental infant day care programs which began to develop about 1965, fostered by the interest of the staff of the National Institute of Mental Health. These are concentrating on preventing culturally determined mental retardation.6, The results thus far appear very favorable. The figures from many group infant care programs 8 which are primarily for service will also be evaluated in due course. Other research programs in early education are concerned for the most part with children two years of age or older.9 9 Developmental Studies with Infants If we confine our citations to those of investigators whose subjects are under one year of age, we find five-with work still in progress -which have published some results.

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