Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.
Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.
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DOI：
10.1186/s12961-016-0079-2
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发表时间：
2016-01-27
影响因子：
4
通讯作者：
Jacobson N
中科院分区：
文献类型：
--
作者：
Quanbeck A;Brown RT;E Zgierska A;A Johnson R;Robinson JM;Jacobson N
采用循证实践发生在一个冰川的地方在医疗保健。这项研究将试行一项创新的实施战略-系统咨询-旨在加快在初级保健中采用循证实践。该策略基于系统工程的原则，并在成瘾治疗中得到了广泛的测试。该战略包括三项创新-将临床实践指南翻译为基于清单的实施指南，使用医生同行教练（“系统顾问”）帮助诊所实施指南，以及专注于减少处方医生和诊所之间的实践差异。实施战略将用于改善初级保健中的阿片类药物处方做法，这可能有助于最终缓解阿片类药物滥用和成瘾日益普遍的情况。试点测试将比较四个干预诊所和四个对照诊所的配对设计。阿片类药物处方的领先临床指南已在一个系统的过程中转化为基于清单的实施指南，该过程涉及与实施专家和初级保健医生协商编写指南的专家。两名在家庭和成瘾医学方面具有专长的医生担任系统顾问。每名系统顾问将指导两个干预诊所，使用两次现场访问和通过电话和电子邮件进行后续沟通，以实施翻译后的指南。将使用混合方法来测试可行性，可接受性和初步有效性的实施战略的评价，满足标准的“充分开发使用”的RE-AIM框架（范围，有效性，采用，实施，维护）。诊所将是主要分析单位。系统咨询实施策略旨在推广到其他临床指南的采用。该试点测试旨在为一项大型随机临床试验做准备，该试验将测试该策略与其他实施策略（如审计/反馈和学术细节）的对比，这些策略用于缩小知识与实践之间的差距。系统咨询方法有可能缩短在医疗保健中实施循证实践和临床指南所需的时间。
Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy – systems consultation –intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy – translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches (‘systems consultants’) to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for ‘fully developed use’ of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.