Changing physician performance. A systematic review of the effect of continuing medical education strategies.
Changing physician performance. A systematic review of the effect of continuing medical education strategies.
复制标题
改变医生的表现。
DOI：
10.1001/jama.1995.03530090032018
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
R. Haynes
中科院分区：
文献类型：
--
作者：
D. Davis;M. Thomson;A. Oxman;R. Haynes
客观的
OBJECTIVE
To review the literature relating to the effectiveness of education strategies designed to change physician performance and health care outcomes.
DATA SOURCES
We searched MEDLINE, ERIC, NTIS, the Research and Development Resource Base in Continuing Medical Education, and other relevant data sources from 1975 to 1994, using continuing medical education (CME) and related terms as keywords. We manually searched journals and the bibliographies of other review articles and called on the opinions of recognized experts.
STUDY SELECTION
We reviewed studies that met the following criteria: randomized controlled trials of education strategies or interventions that objectively assessed physician performance and/or health care outcomes. These intervention strategies included (alone and in combination) educational materials, formal CME activities, outreach visits such as academic detailing, opinion leaders, patient-mediated strategies, audit with feedback, and reminders. Studies were selected only if more than 50% of the subjects were either practicing physicians or medical residents.
DATA EXTRACTION
We extracted the specialty of the physicians targeted by the interventions and the clinical domain and setting of the trial. We also determined the details of the educational intervention, the extent to which needs or barriers to change had been ascertained prior to the intervention, and the main outcome measure(s).
DATA SYNTHESIS
We found 99 trials, containing 160 interventions, that met our criteria. Almost two thirds of the interventions (101 of 160) displayed an improvement in at least one major outcome measure: 70% demonstrated a change in physician performance, and 48% of interventions aimed at health care outcomes produced a positive change. Effective change strategies included reminders, patient-mediated interventions, outreach visits, opinion leaders, and multifaceted activities. Audit with feedback and educational materials were less effective, and formal CME conferences or activities, without enabling or practice-reinforcing strategies, had relatively little impact.
CONCLUSION
Widely used CME delivery methods such as conferences have little direct impact on improving professional practice. More effective methods such as systematic practice-based interventions and outreach visits are seldom used by CME providers.
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DOI：
--
发表时间：
1994
期刊：
The Western journal of medicine
影响因子：
--
作者：
Browner,WS;Baron,RB;Solkowitz,S;Adler,LJ;Gullion,DS
通讯作者：
Gullion,DS
DOI：
--
发表时间：
1988
期刊：
JAMA
影响因子：
--
作者：
Wilson,DM;Taylor,DW;Gilbert,JR;Best,JA;Lindsay,EA;Willms,DG;Singer,J
通讯作者：
Singer,J
一项旨在增加医生吸烟干预的随机试验。
DOI：
--
发表时间：
1989
期刊：
JAMA
影响因子：
--
作者：
Kottke,TE;Brekke,ML;Solberg,LI;Hughes,JR
通讯作者：
Hughes,JR
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DOI：
--
发表时间：
1980
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
McDonald,CJ;Wilson,GA;McCabeJr,GP
通讯作者：
McCabeJr,GP
对初级保健从业者关于骨关节炎管理的教育计划进行评估。
影响因子：
--
作者：
Stross,JK;Bole,GG
通讯作者：
Bole,GG