Demonstrating, testing, and disseminating a sustainable model for academic detailing programs

摘要 卫生保健系统正在寻求缩小实际医疗实践与最佳临床实践之间的差距 循证医学指导下的决策。学术细节(AD)、直接外展教育 从训练有素的专业人员到一线临床医生，在数十项研究中被证明是有效的。许多 卫生保健系统已表示有兴趣实施AD，但缺乏专业知识和资源来 设计一项计划，培训提供外展教育的人员，并评估计划的影响。 由AHRQ支持的国家学术细节资源中心(NaRCAD)已经开发出 该课程已用于培训400多名卫生专业人员的AD技术，并取得了成效 与数十个医疗保健系统和公共卫生部门一起支持规划和实施 AD项目的数量。然而，目前这些组织仍然依赖NaRCAD的直接援助来 接受这种培训和支持。 我们提出了一个演示项目，该项目将开发、测试和传播一组工具，这些工具将 为卫生保健系统提供实施和维持AD方案的能力。第一步将是 全面调查，将详细说明AD计划的当前范围和结构，以及 作为寻求使用此方法的医疗保健系统的需求评估。然后，我们将与 来自领先项目的经验丰富的学术细节人员，以开发和现场测试培训师课程， 在我们现有培训计划的基础上，培养一批能够独立创业的毕业生 持续进行学术细节技巧方面的培训。随着这些新的培训者准备额外的学术 详细人员，我们将向全国医疗保健系统传播培训培训员课程。此外，我们 将与当前使用AD的几个较大的医疗保健系统合作，以制定评估 指南，利用NaRCAD在研究小组中的定位，具有分析多个 医疗保健数据的类型。评价指南将被设计用于新的卫生保健系统 实施或寻求评估和改进其AD计划，并允许系统评估 学术详述者介绍他们的知识、熟练程度和对医疗结果的影响。 最后，我们将把这个演示项目的发现合并到一个全面的工具包中，该工具包 我们将在AHRQ正在进行的比较健康系统的基础上，广泛传播到医疗保健系统 旨在支持学习卫生系统的绩效倡议。医疗保健系统将能够使用 该工具包用于构建独立设计AD计划、培训细节人员并评估他们的技能和 在必要时提供支持，以确保以最高质量开展这些工作。

Abstract Health care systems are seeking to close the gap between actual medical practice and optimal clinical decision making as guided by evidence-based medicine. Academic detailing (AD), direct outreach education from trained professionals to front line clinicians, has been proven effective in scores of research studies. Many health care systems have expressed interest in implementing AD, but lack the expertise and resources to design a program, train personnel to deliver the outreach education, and evaluate the program’s impact. The National Resource Center for Academic Detailing (NaRCAD), supported by AHRQ, has developed a curriculum that has been used to train over 400 health professionals in the techniques of AD and has worked with dozens of health care systems and public health department to support the planning and implementation of AD programs. At present, however, these organizations still rely on direct assistance from NaRCAD to receive this training and support. We propose a demonstration project that will develop, test, and disseminate a set of tools that will provide health care systems with the capacity to implement and sustain AD programs. The first step will be a comprehensive survey that will both characterize in detail the current scope and structure of AD programs and serve as a needs assessment for health care systems seeking to use this approach. We will then work with experienced academic detailers from leading programs to develop and field test a train-the-trainer curriculum, building on our existing training program, to yield a cohort of graduates able to initiate and independently sustain training in the techniques of academic detailing. As these new trainers prepare additional academic detailers, we will disseminate the train-the-trainer curriculum to health care systems nationally. In addition, we will collaborate with several of the larger health care systems currently using AD to develop an evaluation guide, taking advantage of NaRCAD’s positioning in a research group with expertise in analysis of multiple types of healthcare data. The evaluation guide will be designed for use by health care systems newly implementing or seeking to assess and improve their AD programs and will allow systems to evaluate academic detailers on their knowledge, proficiency, and impact on medical outcomes. Finally, we will combine the findings from this demonstration project into a comprehensive toolkit that we will disseminate to health care systems broadly, building on AHRQ’s ongoing Comparative Health System Performance Initiative that seeks to support learning health systems. Health care systems will be able to use the toolkit to build capacity to independently design an AD program, train detailers, and evaluate their skills and impact, with support available as needed to ensure that these efforts are conducted with the highest quality.