Dopson S, Locock L, Chambers D, Gabbay J
Templeton College, UK.
J Health Serv Res Policy. 2001 Jan;6(1):23-31. doi: 10.1258/1355819011927161.
To evaluate the Promoting Action on Clinical Effectiveness (PACE) programme, which sought to implement clinically effective practice in 16 local sites.
182 semi-structured interviews, usually by telephone, with project team members, clinicians, and senior managers and representatives from the Department of Health and the King's Fund.
The most influential factors were strong evidence, supportive opinion leaders and integration within a committed organization; without these factors, projects had little chance of success. Other factors (context analysis, professional involvement and good project management) emerged as important, supporting processes; their presence might be an additional help, but on their own they would not be enough to initiate change. A serious problem with any of them could have a strong adverse impact.
Although there is no simple formula for the factors that ensure successful implementation of research-based improvements to clinical practice, certain principles do seem to help. Time and resource need to be devoted to a period of local negotiation and adaptation of good research evidence based on a careful understanding of the local context, in which opinion leader influence is an important component of a well managed and preferably well integrated process of change.
评估促进临床疗效行动（PACE）项目，该项目旨在在16个本地场所实施临床有效实践。
对项目团队成员、临床医生、高级管理人员以及来自卫生部和国王基金的代表进行了182次半结构化访谈，通常通过电话进行。
最具影响力的因素是有力的证据、支持性的意见领袖以及在一个坚定的组织内进行整合；没有这些因素，项目成功的机会很小。其他因素（背景分析、专业参与和良好的项目管理）作为重要的支持过程出现；它们的存在可能会有所帮助，但仅凭它们自身不足以引发变革。其中任何一个出现严重问题都可能产生强烈的不利影响。
虽然对于确保基于研究的临床实践改进得以成功实施的因素没有简单的公式，但某些原则似乎确实有所帮助。需要投入时间和资源进行一段时间的本地协商，并根据对当地情况的仔细理解对良好的研究证据进行调整，其中意见领袖的影响力是管理良好且最好是整合良好的变革过程的重要组成部分。
