Bruckner M, Mangan M, Godin S, Pogach L
Am J Manag Care. 1999 May;5(5):609-16.
To reduce type 2 diabetes-related lower extremity amputations (LEAs) in New Jersey through a statewide training program for primary care providers at healthcare agencies in high-risk areas.
Project LEAP provided 27 1-day training workshops to 560 healthcare professionals representing 85 organizations. The effect of training was evaluated based on a multiple-choice knowledge test, self-reported practice behaviors, and a medical records audit of practice behaviors, and pre- and postprogram LEA rates.
We evaluated statistically significant differences in pre- and postprogram knowledge scores using Student's t-tests. We also evaluated providers' intentions to change clinical foot-care practices and compared them with actual practices documented in medical records. We used analysis of variance to determine any statistically significant differences in pre- and postprogram LEA rates at various types of institutions. In addition, we assisted facilities in the development of self-education programs containing specific foot-care modules.
Participating providers were: 70.6% nurses, 7.8% physicians, 4.5% podiatrists, 4.2% dietitians, and 12.9% all others. Pre- and postprogram knowledge scores increased by 12% (T = 13.29; P < 0.0001) and were maintained for 9 months (T = 7.58; P < 0.05). Provider intentions to change clinical practice behaviors correlated with self-reported practice changes 9 months postprogram (r = .51; P < 0.001). Medical record audits 1 year before and 9 months after training demonstrated marked improvement in foot-care practices in the following areas: (1) foot-care education given to patients by primary care providers; 2) documentation of peripheral vascular disease; 3) documentation of patient preventive care practices; and 4) referrals to diabetes educators, orthopedists, podiatrists, and diabetologists. Education programs with specific foot-care components increased 10%. The overall incidence of pre- and posttraining LEAs did not change significantly but differed depending on institution type. Hospitals and community healthcare centers were more likely to show postprogram reductions in LEAs than nursing homes and rehabilitation centers.
Institutionalization of a LEAP program resulted in improved provider knowledge and certain clinical practice behaviors. There was a trend toward an overall reduction in the number of LEAs at participating institutions.
通过为高风险地区医疗机构的初级保健提供者开展全州范围的培训项目，减少新泽西州与2型糖尿病相关的下肢截肢（LEA）病例。
“LEAP项目”为代表85个组织的560名医疗保健专业人员提供了27场为期1天的培训工作坊。基于多项选择题知识测试、自我报告的实践行为、实践行为的病历审核以及项目前后的LEA发生率对培训效果进行评估。
我们使用学生t检验评估项目前后知识得分的统计学显著差异。我们还评估了提供者改变临床足部护理实践的意愿，并将其与病历中记录的实际实践进行比较。我们使用方差分析来确定各类机构项目前后LEA发生率的任何统计学显著差异。此外，我们协助各机构制定包含特定足部护理模块的自我教育项目。
参与的提供者包括：70.6%为护士，7.8%为医生，4.5%为足病医生，4.2%为营养师，12.9%为其他人员。项目前后的知识得分提高了12%（T = 13.29；P < 0.0001），并在9个月内保持稳定（T = 7.58；P < 0.05）。项目结束9个月后，提供者改变临床实践行为的意愿与自我报告的实践改变相关（r = 0.51；P < 0.001）。培训前1年和培训后9个月的病历审核显示，以下方面的足部护理实践有显著改善：（1）初级保健提供者向患者提供的足部护理教育；（2）外周血管疾病的记录；（3）患者预防护理实践的记录；（4）转介给糖尿病教育者、骨科医生、足病医生和糖尿病专家。包含特定足部护理内容的教育项目增加了10%。培训前后LEA的总体发生率没有显著变化，但因机构类型而异。与疗养院和康复中心相比，医院和社区医疗中心在项目后LEA减少的可能性更大。
“LEAP项目”的制度化提高了提供者的知识水平和某些临床实践行为。参与机构的LEA数量总体上有减少的趋势。
