Inside the black box: the importance of monitoring treatment implementation.
Inside the black box: the importance of monitoring treatment implementation.
复制标题
黑匣子内部：监控治疗实施的重要性。
DOI：
10.1093/oxfordjournals.schbul.a007107
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发表时间：
2004
影响因子：
6.6
通讯作者：
Weissman,EllenM
中科院分区：
文献类型：
--
作者：
Essock,SusanM;Covell,NancyH;Weissman,EllenM
最初的精神分裂症患者结局研究小组（PORT）治疗建议（1998 a，1998 b）是一个里程碑，因为他们都确定了用于治疗精神分裂症的干预措施，这些干预措施得到了足够的证据基础的支持，并进行了记录审查，以估计精神分裂症患者实际接受这些干预措施的频率。结果治疗已知是有效的（1998年b）。更新显示精神分裂症患者很少接受PORT指南（Lehman et al. 2004），根据最近的证据，该指南提供了一个有用的工具来衡量循证治疗的实施。更新后的PORT报告没有回答一个关键问题：在这期间的几年里，在公共精神卫生系统接受治疗的精神分裂症患者接受循证治疗的几率是否有所提高？本评论将集中在跟踪这个问题的答案的重要性，并需要有效的方法来记录治疗是否提供了忠实于循证模型，提供良好的护理的愿望，本身就是一个重要的激励，以支持实施循证实践。然而，也需要适当的行政和财政奖励，特别是在预算已经大幅削减的系统中。如果没有这些激励措施，我们可以预期创新循证治疗的传播将停滞不前。想要支付有效治疗的支付者以及负责提供这种护理的计划管理员和临床监督员面临着希望提供者以可测量的、可报告的术语量化干预以确认治疗正在以已知有效的方式提供的困难，而同时希望最小化测量对提供者的时间造成的负担。
The original Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations (1998a, 1998b) were a landmark because they both identified interventions used to treat schizophrenia that were supported by an adequate evidence base and conducted record reviews to estimate how often people with schizophrenia actually received these interventions. The results treatments known to be effective (1998b). The updated showed how rarely patients with schizophrenia received PORT guidelines (Lehman et al. 2004) provide a useful tool to measure the delivery of evidence-based treatments according to more recent evidence. The updated PORT report stops short of answering a key question: In the intervening years, have the odds improved that a person with schizophrenia being treated in a public mental health system is receiving evidence-based treatments? This commentary will focus on the importance of tracking the answer to that question and the need for efficient methods to document whether the treatments are delivered with fidelity to the evidence-based models.The desire to provide good care is, in itself, an important incentive to support the implementation of evidence-based practices. However, adequate administrative and fiscal incentives are also necessary, particularly in systems already burdened by significantly reduced budgets. Without these incentives, we can expect dissemination of innovative evidence-based treatments to languish. Payers who want to pay for an effective treatment, and program administrators and clinical supervisors responsible for the delivery of such care, are confronted with the difficulty of wanting the provider to quantify the intervention in measurable, reportable terms to confirm that the treatment is being delivered in a manner known to be effective, while at the same time wanting to minimize the burden that measurement places on the provider’s time.