Sales Anne, Smith Jeffrey, Curran Geoffrey, Kochevar Laura
VA Puget Sound Health Care System and Department of Health Services, University of Washington, Seattle, WA 98108, USA.
J Gen Intern Med. 2006 Feb;21 Suppl 2(Suppl 2):S43-9. doi: 10.1111/j.1525-1497.2006.00362.x.
This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventions and/or intervention components to be implemented, and the choice of tools should match the interventions and overall strategy, linking back to the original theory and framework. The thesis advanced is that in most studies where there is an attempt to implement planned change in clinical processes, theory is used loosely. An example of linking theory to intervention design is presented from a Mental Health Quality Enhancement Research Initiative effort to increase appropriate use of antipsychotic medication among patients with schizophrenia in the Veterans Health Administration.
本文提出了一个案例，以供在计划将循证实践应用于临床护理时认真考虑理论。如前所述，理论应通过精心选择或创建实施框架与战略规划紧密相连。策略应与要实施的具体干预措施和/或干预组成部分相联系，工具的选择应与干预措施和总体策略相匹配，并回溯到原始理论和框架。本文提出的论点是，在大多数试图对临床流程进行计划变革的研究中，理论的运用较为松散。文中给出了一个将理论与干预设计相联系的例子，该例子来自一项心理健康质量提升研究倡议，旨在增加退伍军人健康管理局中精神分裂症患者抗精神病药物的合理使用。
