Using Patient-Reported Outcome Measures to Promote Patient-Centered Practice: Building Capacity Among Pediatric Physiotherapists in Rwanda.
Using Patient-Reported Outcome Measures to Promote Patient-Centered Practice: Building Capacity Among Pediatric Physiotherapists in Rwanda.
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使用患者报告的结果措施促进以患者为中心的实践：在卢旺达儿科物理治疗师的能力建设。
DOI：
10.9745/ghsp-d-19-00408
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发表时间：
2020-09-30
期刊：
影响因子：
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通讯作者：
Braxley B
中科院分区：
文献类型：
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作者：
Mann M;Musabyemariya I;Harding L;Braxley B
跟踪结果对于评估卫生系统的有效性是不可或缺的。在低资源环境下，提供多模式培训，使用适合背景的、以患者为中心的结果衡量标准。这些结果为设计未来的能力建设方案提供了见解。92%的受访者表示，他们对自己确立职能目标的能力“相当”或“非常”有信心。70%的受访者表示，在拨款结束26个月后，他们继续使用患者报告的结果衡量标准。完成培训后：针对来自卫生系统各个层面的利益相关方，促进对实践变化的系统和机构支持，并最大限度地采用、渗透和持续采用新技能和概念，采用文化上合适的结果测量工具，使用多模式能力建设战略，计划经理应考虑：患者报告结果测量(PROM)评估残疾和朝着功能目标的进展，同时促进以患者为中心的实践。它们可以由卫生专业人员在任何专业和多种环境中使用。这项研究回顾了在卢旺达与儿科理疗师一起开展的能力建设计划的实施战略和经验教训。在卢旺达，将PROMS的使用和以患者为中心的实践纳入了向164名参与者提供的连续4个持续专业发展课程。我们试图找出一种在跨文化环境中被证明有效的简单的通用测量方法。之所以选择患者专用功能量表，是因为它易于使用，并能够测量各种患者情况下的变化。授课课堂培训和临床实地访问是能力建设战略的两个基本教学要素。现场访问可用于评估技能水平和促进将知识转移到患者护理环境。对独特的卢旺达同事进行了培训，以便在每门课程中担任合作教师，以最大限度地提高新技术的可持续性。这项研究提供了完成48小时儿科康复课程的65名参与者的数据。在课堂教学后，78%的参与者被观察到独立地与他们的患者一起确定功能限制。此外，前后测试表明，治疗师在参加课程后大大增加了他们对以患者为中心的实践的理解。在项目结束26个月后进行的访谈显示，在可持续使用PROM方面取得了好坏参半的结果，尽管人们对PROM的信心仍然很高。在新实践的长期可持续性方面的挑战要求注意，在引入新方法时，不仅需要针对临床医生，而且需要针对卫生部、医院管理和大学教职员工。从这项研究中学到的经验教训可能对其他在低收入和中等收入国家规划能力建设计划的医疗专业人员有用。
Tracking outcomes is integral to assessing effectiveness of health systems. Multimodal training was offered in the use of a contextually appropriate, patient-centered outcome measure in a low-resource setting. Results offer insights for designing future capacity-building programs. Ninety-two percent of respondents stated that they felt either “quite” or “very” confident in their abilities to establish functional goals. Seventy percent of respondents stated that they continue to use patient-reported outcome measures either “a lot” or “quite a bit” 26 months after the close of the grant. After completing the training: Targeting stakeholders from a range of health system levels to facilitate systemic and institutional support of practice changes as well as maximize adoption, penetration, and sustainability of new skills and concepts Adopting culturally appropriate outcome measure tools Using multimodal strategies for capacity building Program managers should consider: Patient-reported outcome measures (PROMs) assess disability and progress toward functional goals while promoting patient-centered practice. They can be used by health professionals in any specialty and in a multitude of settings. This study reviews implementation strategies and lessons learned in a capacity-building program that took place with pediatric physiotherapists in Rwanda. Use of PROMs and patient-centered practice were integrated into 4 consecutive continuing professional development courses offered to 164 participants in Rwanda. We sought to identify a simple generic measure with proven validity in cross-cultural settings. The Patient-Specific Functional Scale was chosen due to its ease of use and ability to measure change in a wide range of patient conditions. Didactic classroom training and clinical site visits were 2 essential pedagogical elements of the capacity-building strategy. Site visits allowed for evaluation of skill levels and facilitation of knowledge transfer to patient care settings. Unique pairs of Rwandan colleagues were trained to serve as coteachers in each course to maximize sustainability of new techniques. This study presents data on a subset of 65 participants who completed a 48-hour pediatric rehabilitation course. After classroom instruction, 78% of participants were observed independently determining functional limitations with their patients. Additionally, pre- and post-tests indicated that therapists substantially increased their understanding of patient-centered practice after attending courses. Interviews conducted 26 months after the conclusion of the project revealed mixed success in sustainability of the use of PROMs, although perceived confidence remained high. Challenges in long-term sustainability of new practices call attention to the need to target not only clinicians when introducing new methodologies, but also the Ministry of Health, hospital administration, and university faculty. Lessons learned from this study may be useful to other medical professionals planning capacity-building programs in low- and middle-income countries.