Sherman Scott E, Fotiades John, Rubenstein Lisa V, Gilman Stuart C, Vivell Susan, Chaney Edmund, Yano Elizabeth M, Felker Bradford
Veterans Health Administration (VA) New York Harbor Healthcare System, New York, New York 10010, USA.
Acad Med. 2007 Feb;82(2):168-75. doi: 10.1097/ACM.0b013e31802d9165.
Although health care organizations seeking to improve quality often must change the system for delivering care, there is little available evidence on how to educate staff and providers about this change. As part of a 2002-2003 Veterans Health Administration multisite project using collaborative care to improve the management of depression, the authors implemented the Translating Initiatives for Depression into Effective Solutions (TIDES) program. Five steps were followed for teaching systems-based practice: (1) determine providers' educational needs (through administrative data, expert opinion, and provider discussion), (2) develop educational materials (based on needs assessed), (3) help each of seven sites develop an educational intervention, (4) implement the intervention, and (5) monitor the intervention's effectiveness. Sites relied primarily on passive educational strategies. There was variable implementation of the different components (e.g., lecture, educational outreach). No site chose to write up its education plan, as was suggested. The authors thus suggest that the educational model was successful at identifying providers' needs and creating appropriate materials, because the program was not advertised in other ways and because almost all providers referred patients to the program. However, the educational model was only partially successful at getting sites to develop and implement an educational plan, although provider behavior did change. Overall, the program was somewhat effective at teaching systems-based practice. The authors believe the best way to enhance effectiveness is to build education into the system rather than rely on a separate system for education.
尽管寻求提高医疗质量的医疗机构通常必须改变护理提供系统，但关于如何就这种改变对工作人员和医疗服务提供者进行教育的现有证据却很少。作为2002 - 2003年退伍军人健康管理局多地点项目的一部分，该项目采用协作护理来改善抑郁症管理，作者实施了“将抑郁症治疗倡议转化为有效解决方案”（TIDES）项目。基于系统的实践教学遵循了五个步骤：（1）确定医疗服务提供者的教育需求（通过行政数据、专家意见和医疗服务提供者讨论），（2）开发教育材料（基于评估的需求），（3）帮助七个地点中的每一个制定教育干预措施，（4）实施干预措施，以及（5）监测干预措施的效果。各地点主要依赖被动教育策略。不同组成部分（如讲座、教育推广）的实施情况各不相同。没有一个地点按照建议撰写其教育计划。因此，作者认为该教育模式在识别医疗服务提供者的需求和创建合适材料方面是成功的，因为该项目没有通过其他方式进行宣传，而且几乎所有医疗服务提供者都将患者转诊到该项目。然而，尽管医疗服务提供者的行为确实发生了变化，但该教育模式在促使各地点制定和实施教育计划方面仅取得了部分成功。总体而言，该项目在基于系统的实践教学方面有一定效果。作者认为提高效果的最佳方法是将教育融入系统，而不是依赖单独的教育系统。
