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教育计划，以传播有关护理老年痴呆症疗养院居民的循证指南，重点关注非典型抗精神病药物的适当使用。2005年，美国食品和药物管理局发布了一项咨询和随后的“黑匣子”警告，关于老年痴呆症患者使用非典型抗精神病药物的死亡风险增加。2009年，AMDA使用基于证据和共识的方法制定了管理养老院痴呆患者的临床实践指南，总体项目目标是通过提供创新的，基于技术的，低成本传播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。协会将改进其传播方法，实施和评估一个基于成人学习理论的在线互动式继续医学教育课程，该课程采用个性化学习方法、基于问题的学习和即时反馈的测试。互动技术功能将被整合到课程中，提供者将能够使用智能手机和平板电脑远程访问课程。该项目的目标是：（1）最少700名护养院医疗主任及临床医生将完成继续医学教育课程;（2）最少90%完成AMDA课程的临床处方医生，在测试他们对临床实践指南的了解时，得分将达到80%或以上;（3）至少75%的调查响应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%的调查响应者将减少痴呆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）在已将本计划纳入其质量改进项目的组织中，至少有75%的人将报告减少痴呆患者不适当的抗精神病药物使用。在每个课程模块完成后，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，以评估他们将获得的知识融入临床实践。关于这些结果的信息将作为在线后续调查的一部分收集。对于不适当的抗精神病药物使用率、指南的整合和纳入QI，将回顾性评估CME前课程实践;将使用线性回归将CME前课程水平与CME后水平进行比较。对于知识保留，将使用双变量分析将协变量作为潜在混杂因素进行评价，并纳入线性回归模型中。在项目结束时，将编写一份项目成果草稿，提交给协会的同行审查出版物《协会期刊》。

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.