Organizational interventions to encourage guideline implementation
Organizational interventions to encourage guideline implementation
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DOI：
10.1378/chest.118.2_suppl.40s
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发表时间：
2000-08-01
期刊：
影响因子：
9.6
通讯作者：
Curry, SJ
中科院分区：
文献类型：
--
作者：
Curry, SJ
循证指导方针为继续改善卫生保健提供提供了相当大的希望。然而，临床实践指南的可获得性并不自动导致实践模式的变化。利用“推-拉-能力”模型，本文描述了改善三类组织(国家组织、保险公司和医疗保健组织以及医疗保健购买者)指南实施的策略，推动策略侧重于指南制定过程，包括对同行评议研究的严格审查和荟萃分析，以及使用多学科专家团队，对指南进行同行评审和评论，并使用可测量的临床结果来定义指南。Pull战略侧重于创造对指南实施的需求，包括专业组织认可、基于指南相关结果的质量衡量以及购买者合同和医生补偿协议中基于指南的绩效目标。能力战略侧重于促进准则执行的系统。范例战略是为基于指南的治疗方案提供福利覆盖和补偿，并实施基于人群的跟踪、结果监测和基准反馈的临床信息系统。
Evidence-based guidelines hold considerable promise for continued improvement of health-care delivery. However, the availability of clinical practice guidelines does not automatically lead to changes in practice patterns. Using a "push-pull-capacity" model, this article describes strategies to improve guideline implementation for three types of organizations: national organizations, insurer and health-care organizations, and health-care purchasers, Push strategies focus on the guideline development process and include rigorous review and meta-analysis of peer-reviewed research, and use of multidisciplinary expert teams, subjecting guidelines to peer review and comment and using measurable clinical outcomes to define guidelines. Pull strategies focus on creating a demand for guideline implementation and include professional organization endorsement, quality measures based on guideline-related outcomes, and guideline-based performance objectives in purchaser contracts and physician compensation agreements. Capacity strategies focus on systems that facilitate guideline implementation. Example strategies are providing benefit coverage and reimbursement for guideline-based treatment protocols, and implementing clinical information systems for population-based tracking, outcomes monitoring, and benchmarking feedback.