从最佳证据到最佳实践:有效实施患者护理变革
Richard Grol1, Jeremy Grimshaw
1Centre for Quality of Care Research (WOK), Universities of Nijmegen and Maastricht, PO Box 9101, WOK 229 6500 HB, Nijmegen, Netherlands. r.grol@wok.umcn.nl
Lancet (London, England)
|October 22, 2003
概括
实施以证据为基础的实践面临挑战,因为患者往往接受的护理不足于最佳水平. 针对特定环境而定制的综合性,多层次的策略对于改变医疗实践和改善患者结果是最有效的.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善医疗实践 改善医疗实践
- 基于证据的医学实施.
背景情况:
- 临床证据/指南与常规医疗实践之间存在重大差距.
- 低于最佳的患者护理,包括不充分或过度使用治疗方法是常见的.
- 将证据转化为实践的有效策略仍然不清楚.
研究的目的:
- 为改变医疗实践的举措提供当前知识的概述.
- 确定有效和高效的证据实施方法.
- 了解影响采用临床指南的因素.
主要方法:
- 对旨在改变医疗实践的举措进行系统审查.
- 分析有关不同实施策略有效性的证据.
- 评估影响医疗保健环境行为变化的因素.
主要成果:
- 在医疗实践中改变行为是可以实现的,但需要全面的,多层次的干预.
- 策略必须根据特定的环境,目标群体和证据的性质来定制.
- 没有一种单一的方法在所有情况下普遍优于其他方法.
结论:
- 有效实施证据和指导方针需要量身定制的,多方面的战略.
- 了解障碍物和促进因素对于成功的实践变革至关重要.
- 一种特定于环境的方法对于通过证据翻译优化患者护理至关重要.
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