EVIDENCE FOR THE EFFECTIVENESS OF CME - A REVIEW OF 50 RANDOMIZED CONTROLLED TRIALS
EVIDENCE FOR THE EFFECTIVENESS OF CME - A REVIEW OF 50 RANDOMIZED CONTROLLED TRIALS
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DOI：
10.1001/jama.268.9.1111
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发表时间：
1992-09-02
影响因子：
120.7
通讯作者：
HAYNES, RB
中科院分区：
文献类型：
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作者：
DAVIS, DA;THOMSON, MA;HAYNES, RB
目的.-评估多样化的继续医学教育 (CME) 干预措施对医生绩效和医疗保健结果的影响。数据源.-使用继续医学教育和相关短语，我们对 1975 年至 1991 年的索引文献（MEDLINE、社会科学索引、国家技术信息服务和教育研究信息交换所）进行定期搜索。此外，这些年来，我们使用手动搜索、关键信息提供者以及要求作者查找其他索引文章和成人和继续专业教育的非索引文献。研究选择。-从结果数据库中，我们选择了符合以下标准的研究：随机对照试验；教育计划、活动或其他干预措施；涉及 50% 或更多医生的研究；对至少 75% 的研究对象进行后续评估；以及对医生表现或医疗保健结果的客观评估。数据提取。-对研究进行了审查，以获取与医生专业和环境相关的数据。继续医学教育干预措施按其活动模式分为诱发、促进或促进。使用原始研究人员提供的统计测试，医生的表现结果和患者结果被分为阳性、阴性或不确定。数据综合。-我们找到了 777 项 CME 研究，其中 50 项符合所有标准。其中 32 项分析了医生的表现；七项评估患者的治疗结果； 11 检查了这两项措施。 43 项关于医生绩效的研究中的大多数在资源利用、咨询策略和预防医学的一些重要指标方面显示出积极的结果。在 18 项医疗保健结果研究中，有 8 项表明患者的医疗保健结果发生了积极变化。结论：使用实践支持或强化策略的广义 CME 干预措施持续改善医生绩效，并在某些情况下改善医疗保健结果。
Objective.-To assess the impact of diverse continuing medical education (CME) interventions on physician performance and health care outcomes.Data Sources.-Using continuing medical education and related phrases, we performed regular searches of the indexed literature (MEDLINE, Social Science Index, the National Technical Information Service, and Educational Research Information Clearinghouse) from 1975 through 1991. In addition, for these years, we used manual searches, key informants, and requests to authors to locate other indexed articles and the nonindexed literature of adult and continuing professional education.Study Selection.-From the resulting database we selected studies that met the following criteria: randomized controlled trials; educational programs, activities, or other interventions; studies that included 50% or more physicians; follow-up assessments of at least 75% of study subjects; and objective assessments of either physician performance or health care outcomes.Data Extraction.-Studies were reviewed for data related to physician specialty and setting. Continuing medical education interventions were classified by their mode(s) of activity as being predisposing, enabling, or facilitating. Using the statistical tests supplied by the original investigators, physician performance outcomes and patient outcomes were classified as positive, negative, or inconclusive.Data Synthesis.-We located 777 CME studies, of which 50 met all criteria. Thirty-two of these analyzed physician performance; seven evaluated patient outcomes; 11 examined both measures. The majority of the 43 studies of physician performance showed positive results in some important measures of resource utilization, counseling strategies, and preventive medicine. Of the 18 studies of health care outcomes, eight demonstrated positive changes in patients' health care outcomes.Conclusion.-Broadly defined CME interventions using practice-enabling or reinforcing strategies consistently improve physician performance and, in some instances, health care outcomes.