A national academic detailing resource to adapt and disseminate CER findings

描述（由申请人提供）：尽管有越来越多的CER审查，但非循证处方很常见。“学术细节”是由我们的团队在30年前开创的一种教育推广方法，以用户友好的交互式格式为处方医生提供准确，非商业和相关的药物数据，已被证明可以改变实践。鉴于其有据可查的有效性，许多组织，包括许多医疗补助计划，寻求实施自己的计划，但缺乏这样做的专业知识和支持。我们建议开发一个国家资源中心，以适应AHRQ的CER产品的AD，并培训临床医生，教育工作者在AD的方法来传播这些信息在各种各样的设置。提供有关AD技术和内容的培训，建立此类计划的指导，以及提供适用于AD的AHRQ产品，将使服务于不同患者人群（包括许多可能受益最多的弱势和服务不足的患者）的组织能够将循证信息转化为改善的患者护理决策。我们将开始建立一个组织网络，争取在各自的环境中执行人权问题咨询委员会的评价结果。我们已经收到了来自26个组织的支持和兴趣的信件，其中包括十几个医疗补助计划。该中心将与合作伙伴组织合作，对其目前的药物使用模式进行需求评估，并为建立AD计划奠定基础。接下来，我们将调整AHRQ的CER结果的四个临床领域（口服糖尿病药物，胰岛素，非典型抗精神病药物的痴呆症，和止痛剂的骨关节炎）到一个适合的形式有效的AD。我们将提供关于社会营销原则、AD技术和改编CER结果的临床内容的培训课程;这些课程将在项目期间多次提供。然后，我们将与每个合作伙伴组织合作，从多个维度评估其广告活动。我们将收集有关实施过程、培训质量以及临床医生接收AD信息的经验的定性数据。对于州医疗补助计划，我们已经可以访问汇总数据，我们将使用这些数据对处方模式的详细影响进行定量评估，并且我们将从非医疗补助合作伙伴组织获得类似数据以进行类似评估。我们还将为参与计划提供指导，以便对其干预措施的影响进行患者层面的评估。该项目将创建一个社区，使用这种方法来传播非商业性的，基于证据的信息，药物的好处和风险。这将使我们能够确定预测成功的AD计划的因素以及要避免的陷阱。在项目期的第三年，我们将组织一次关于AD的大型会议，汇集与我们合作的组织以及寻求了解如何建立自己的外展计划的其他组织。 公共卫生相关性：AHRQ支持的CER审查和临床医生指南确定了最佳处方方法，但如果更积极地传播，它们对护理的影响可能会更大。学术细节，建立在社会营销的技术，是一个强大的和证明的教育推广手段，以改变处方实践。我们建议建立一个国家资源中心，以适应AHRQ的CER产品AD，以及创建一个资源，培训外展教育工作者在实施这种方法。

DESCRIPTION (provided by applicant): Despite the availability of a growing body of CER reviews, non-evidence-based prescribing is common. "Academic detailing" was pioneered by our team 30 years ago as a method of educational outreach that provides prescribers with accurate, non-commercial, and relevant data on medications in a user-friendly, interactive format that has been shown to change practice. Given its well documented effectiveness, many organizations, including numerous Medicaid programs, seek to implement programs of their own but lack the expertise and support to do so. We propose to develop a national resource center to adapt AHRQ's CER products for AD, and to train clinician-educators in AD methods to disseminate this information in a wide variety of settings. The availability of training on the techniques and content of AD, guidance on the establishment of such programs, and provision of adapted AHRQ products to use in AD will allow organizations that serve diverse patient populations, including many of the vulnerable and underserved patients likely to benefit most, to transform evidence-based information into improved patient-care decisions. We will begin by establishing a network of organizations seeking to implement the findings of AHRQ's CER findings in their own settings. We have received letters of support and interest from 26 organizations, including over a dozen Medicaid programs. The center will work with partner organizations to perform needs assessment of their current drug use patterns and lay the groundwork for establishing AD programs. Next we will adapt AHRQ's CER findings for four clinical areas (oral diabetes medications, insulin, atypical anti-psychotic drugs in dementia, and analgesics for osteoarthritis) into a form appropriate for effective AD. We will provide training sessions on the principles of social marketing, techniques of AD, and the clinical content of the adapted CER findings; these sessions will be offered on multiple occasions during the project period. We will then work with each partner organization to evaluate its AD activities across multiple dimensions. We will gather qualitative data on the process of implementation, the quality of training, and the experiences of clinicians receiving the AD messages. For state Medicaid programs we already have access to aggregate data that we will use to perform quantitative evaluations of the impact of detailing on prescribing patterns, and we will obtain analogous data from non-Medicaid partner organizations to perform similar evaluations. We will also provide guidance to participating programs on performing patient-level assessments of the impact of their interventions. The project will create a community of programs using this approach to disseminate non-commercial, evidence-based information on medication benefits and risks. This will enable us to identify factors that predict successful AD programs as well as pitfalls to avoid. In Year 3 of the project period, we will organize a large-scale conference on AD to bring together the organizations that partner with us as well as additional organizations that seek to learn about establishing such outreach programs of their own. PUBLIC HEALTH RELEVANCE: AHRQ-supported CER reviews and clinician guides identify best approaches to prescribing, but their impact on care could be far greater if they were more actively disseminated. Academic detailing, built on the techniques of social marketing, is a powerful and proven means of educational outreach to change prescribing practice. We propose creating a national resource center to adapt AHRQ's CER products for AD, as well as create a resource to train outreach educators in implementing this approach.