Practice-based research in primary care: facilitator of, or barrier to, practice improvement?
Practice-based research in primary care: facilitator of, or barrier to, practice improvement?
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DOI：
10.1370/afm.341
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发表时间：
2005-07-01
影响因子：
4.4
通讯作者：
Holtrop, Jodi Summers
中科院分区：
文献类型：
--
作者：
Bodenheimer, Thomas;Young, Denise M;Holtrop, Jodi Summers
目的：初级保健实践研究在哪些方面是实践改进的促进者，还是实践变革的障碍？本文旨在提醒研究人员在实施研究和实践改进的双重议程时可能面临的陷阱。方法：我们通过与17名健康处方(P4H)受赠者的口头交流、访谈和现场访问的实地笔记以及受赠者对P4H分析团队管理的在线日记的记录，获得了研究和实践改进目标之间的关系的例子。结果：分析了关键主题，确定了促进和阻碍研究和实践改进双重目标的因素。进行机构审查委员会授权的研究的要求，包括患者登记和同意，往往构成实践改进的障碍。进行研究和改进活动的做法的选择以及采用这些做法的方式可能会影响研究和实践改进目标的结果。以有时间限制的项目思维来处理实践可能会干扰永久实践更改的过程。RE-AIM结构在设计促进实践改进的研究干预措施时是有用的。结论：融合研究研究和实践改进目标的项目必须注意研究和实践改进之间的潜在冲突，并且必须尝试设计研究性研究以促进而不是抑制实践改进。
PURPOSE: In what ways is primary care practice-based research a facilitator of practice improvement vs a barrier to practice change? This article aims to alert investigators to the pitfalls they may face in undertaking the dual agenda of research and practice improvement.METHODS: We derived examples of the relationship between the research and practice improvement goals of 17 Prescription for Health (P4H) grantees from verbal communications with the grantees, field notes from interviews and site visits, and entries made by grantees to an online diary managed by the P4H Analysis Team.RESULTS: An analysis of key themes identified factors facilitating and impeding the dual goals of research and practice improvement. The requirements of conducting research mandated by institutional review boards, including patient enrollment and consent, often constituted barriers to practice improvement. The choice of practices in which to conduct research and improvement activities and the manner in which the practices are approached may affect the outcome of both research and practice improvement goals. Approaching practices with a time-limited project mentality can interfere with a process of permanent practice change. The RE-AIM construct (reach, efficacy/effectiveness, adoption, implementation, and maintenance) is useful in designing research interventions that facilitate practice improvement.CONCLUSIONS: Projects that meld research studies and practice improvement goals must pay attention to the potential conflicts between research and practice change, and must attempt to design research studies so that they facilitate rather than inhibit practice improvement.