Improving Obesity Outcomes through Interactive Web-Based Clinical Skills Training

描述(由申请人提供)：尽管USPSTF建议所有临床医生对成人肥胖进行干预(AHRQ，2003)，但只有不到一半的患者接受了肥胖症的评估、咨询或其他治疗。该项目将为初级保健提供者(PCP)创建一个创新的基于网络的持续专业发展计划，可在：//www.ImpactObesity.com上获得，以改善对肥胖成年人的PCP护理。现有的教育模式倾向于授课学习而不是技能培训，在提高PCP核心能力方面效果不佳。ImpactObesity.com计划将转而专注于教授与成人肥胖评估和治疗相关的核心医生能力，确定潜在的实践改进，并指导这些改进的实施。将解决一些关键领域，如医生对治疗肥胖症缺乏信心，对超重和肥胖患者的负面态度，以及报销问题和时间有限等障碍。计划材料将包括绩效改善指南、患者健康改善工具、资源中心和大约4小时的AMA PRA 1类积分。创新：ImpactObesity.com计划将根据学习者的专业经验/培训和练习环境量身定做，产生个性化的培训计划。教学设计和功能方面的创新将体现在1)交互式临床案例场景中，其中包括用于临床查询的模拟电子病历(SEMR)，以及2)通过互联网聊天进行的远程实时标准化患者(RLSP)访谈。通过RLSP，用户能够练习特定的临床技能(例如，筛查或讨论体重问题)。基于RLSP的反馈将远远超过标准的正确/不正确答案，而是找出不足之处并建议对绩效较低的领域做出回应。调查人员/顾问：调查人员和公司在为卫生专业人员开发、部署和支持基于网络的培训方面拥有专业知识。一个专家小组将监督内容创建和培训，以确保其重点放在最佳做法上。方法：第一阶段将通过精心计划的形成性分析来开发课程，包括文献回顾、目标受众需求分析调查、半结构化访谈、活跃的专家小组和原型的可用性测试。在第一阶段结束时，专家小组将评估第一阶段的里程碑是否已经实现，以及项目是否应该继续进行。将解决不足之处，并将结果提交专家小组重新审查。第二阶段的评估研究将评估干预是否提高了PCP的核心能力，并证明了与肥胖预防和治疗有关的能力、表现、临床和沟通技能所显示的更好的培训。当医生采取行动，将具体的、循序渐进的、可衡量的改进整合到他们的实践中时，患者的结果最终将得到改善。 公共卫生相关性：初级保健提供者(PCP)的定位是帮助三分之一的美国肥胖者以及有肥胖风险的成年患者-然而，建议的护理与患者接受的护理之间存在巨大的实践差距。由于只有不到一半的患者接受了肥胖症的评估、咨询或其他治疗，因此对卫生专业人员进行基于网络的培训，以正确评估超重患者、筛查和治疗并存疾病以及适当的沟通，可能会对肥胖症的流行产生重大而戏剧性的影响。目前，还不存在这样的培训；卫生专业人员还没有提供可扩展的、经济高效的解决方案，专注于改进实践和影响患者结果。

DESCRIPTION (provided by applicant): Though the USPSTF recommends all clinicians intervene with obese adults (AHRQ, 2003), less than half of patients are assessed, counseled, or otherwise treated for obesity. This project will create an innovative web-based continuing professional development program for primary care providers (PCPs) available at: //www.ImpactObesity.com to improve PCP care of obese adults. Existing educational paradigms favor didactic learning over skills training and have been ineffective in improving PCP core competencies. The ImpactObesity.com program will instead focus on teaching core physician competencies related to assessment and treatment of adult obesity, identifying potential practice improvements, and guiding implementation of these improvements. Key areas such as lack of physician confidence in treating obesity, negative attitudes towards overweight and obese patients, and barriers such as reimbursement issues and limited time will be addressed. Program materials will include performance improvement guides, patient health improvement tools, a resource center, and approximately 4 hours of AMA PRA Category 1 Credit". Innovation: The ImpactObesity.com program will be tailored to the learner's professional experience/training and practice setting, yielding an individualized training program. Innovation in both instructional design and functionality will be seen in 1) interactive clinical case scenarios that include a simulated electronic medical record (sEMR) for clinical queries, and 2) remote live standardized patient (RLSP) interviews performed via Internet chat. Through the RLSP users are able to practice specific clinical skills (e.g., screening or discussing weight issues). Feedback based on the RLSP will far surpass standard correct/incorrect answers and instead identify deficiencies and recommended response to areas of low performance. Investigators/Consultants: The investigators and company have expertise in developing, deploying and supporting web-based training for health professionals. An expert panel will oversee content creation and training to ensure it focuses on best practice. Approach: Phase I will develop the curriculum with a carefully planned formative analysis involving literature review, target audience needs analysis surveys, semi-structured interviews, an active expert panel, and usability testing of a prototype. At the completion of Phase I, the expert panel will assess if Phase I milestones have been met and if the project should proceed. Deficiencies will be addressed, and the results presented to the expert panel for re-review. An evaluative study in Phase II will assess if the intervention improves PCP's core competencies and demonstrates better training as shown by competency, performance, clinical, and communication skills related to obesity prevention and treatment. When physicians act to integrate specific, step-by-step, measurable improvements into their practices, patient outcomes will ultimately be improved. PUBLIC HEALTH RELEVANCE: Primary care providers (PCPs) are positioned to assist the one third of Americans who are obese as well as adult patients at risk for obesity - yet there is a dramatic practice gap between the recommended care and the care that patients are receiving. Since less than half of patients are assessed, counseled, or otherwise treated for obesity, Web-based training for health professionals in the proper assessment of overweight patients, screening and treatment for comorbid disorders, and appropriate communication could have a significant and dramatic effect on the obesity epidemic. At this time, no such training exists; there is no program available to health professionals that offers a scalable, cost-effective, solution focusing on improving practice and impacting patient outcomes.