Development and evaluation of online CME course for disseminating clinical guidel

描述(由申请人提供)：美国医学主任协会(AMDA)建议在其网站上开发一个在线、互动的教育计划，以传播照顾患有痴呆症的疗养院居民的循证指南，重点是适当使用非典型抗精神病药物。2005年，美国食品和药物管理局发布了关于使用非典型抗精神病药物的老年痴呆症患者死亡风险增加的咨询和随后的“黑箱”警告。2009年，AMDA使用循证和共识的方法制定了疗养院居民痴呆症管理的临床实践指南，总体项目目标是通过提供一种创新的、以技术为基础的低成本手段来传播AMDA的循证临床实践指南，以识别、评估、治疗/管理和监测痴呆症患者，从而减少疗养院居民，特别是痴呆症患者不适当地使用抗精神病药物。AMDA将改进其传播方法，实施和评估一门基于成人学习理论的在线、互动的继续医学教育课程，该课程利用个性化学习方法、基于问题的学习和具有即时反馈的测试。互动技术功能将被整合到课程中，提供商将能够使用智能手机和平板电脑远程访问该课程。该项目的目标是：(1)至少700名疗养院医务主任和临床医生将完成继续医学教育课程；(2)至少90%完成AMDA课程的临床处方医生在对其临床实践指南的了解进行测试时，得分将达到80%或更高；(3)至少75%的调查应答者将报告他们已将痴呆症实践指南纳入其临床实践；(4)至少75%的调查应答者将减少痴呆症患者不适当的抗精神病药物使用纳入其组织的质量改进项目；(5)在将该计划纳入其质量改进项目的组织中，至少75%的组织将报告痴呆症患者不适当地使用抗精神病药物。在完成每个课程模块后，提供者将完成一系列简短的在线测试问题，以评估他们对临床实践指南的了解。课程完成者将在测试后3个月和6个月接受调查，以评估他们将所学知识融入临床实践的情况。关于这些结果的信息将作为在线后续调查的一部分进行收集。对于不适当的抗精神病药物使用率、指南的整合和纳入QI，将回顾评估继续医学教育前的课程实践；使用线性回归将继续医学教育前的课程水平与继续医学教育后的水平进行比较。对于知识保留，协变量将使用双变量分析作为潜在的混杂因素进行评估，并包括在线性回归模型中。在项目结束时，将编写一份项目成果的手稿，以提交给AMDA的同行审查出版物《JAMDA》。

DESCRIPTION (provided by applicant): The American Medical Directors Association (AMDA) proposes to develop an online, interactive educational program on its website to disseminate evidence-based guidelines on caring for nursing home residents with dementia, focusing on the appropriate use of atypical antipsychotic medications. In 2005, the Food and Drug Administration issued an advisory and subsequent "black box" warning regarding the increased risk of death in elderly patients with dementia using atypical antipsychotics. In 2009, the AMDA developed clinical practice guidelines for the management of nursing home residents with dementia using both evidence- and consensus- based approaches, The overall project goal is to decrease inappropriate use of antipsychotics for nursing home residents, particularly those with dementia, by providing an innovative, technology-based, and low-cost means of disseminating AMDA's evidence-based clinical practice guidelines for recognition, assessment, treatment/management and monitoring of residents with dementia. AMDA will revamp its dissemination methods, implementing and evaluating an online, interactive, CME course founded on adult learning theory that utilizes a personalized learning approach, problem-based learning, and testing with immediate feedback. Interactive technology features will be integrated into the curriculum and providers will be able to access the course remotely using smart phones and tablet computers. The project's objectives are: (1) At least 700 Nursing Home Medical Directors and clinicians will complete the CME course; (2) At least 90% of clinical prescribers that complete the AMDA course will achieve a score of 80% or higher when tested on their knowledge of the clinical practice guidelines; (3) At least 75% of survey responders will report that they have integrated the dementia practice guidelines into their clinical practice; (4) At leat 75% of survey responders will integrate reduction of inappropriate antipsychotic medication use in patients with dementia into their organizations' quality improvement projects; and (5) Of the organizations that have integrated this program into their quality improvement projects, at least 75% will report the reduction of inappropriate antipsychotic medication use in patients with dementia. At the completion of each course module, providers will complete a series of brief online test questions to assess their knowledge of the clinical practice guidelines. Course completers will be surveyed at 3 and 6 months post-test to evaluate their integration of acquired knowledge into clinical practice. Information on these outcomes will be collected as a part of the online, follow-up survey. For rate of inappropriate antipsychotic use, integration of guidelines, and inclusion in QI, pre-CME course practices will be assessed retrospectively; pre-CME course levels will be compared to post-CME levels using linear regression. For knowledge retention, covariates will be evaluated as potential confounders using bivariate analysis and included in a linear regression model. At the end of the project, a manuscript of the project results will be prepared for submission to the AMDA's peer-reviewed publication, JAMDA.