Carek Peter J, Dickerson Lori M, Boggan Holly, Diaz Vanessa
Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29406, USA.
Fam Med. 2009 Apr;41(4):249-54.
Clinical practice guidelines are useful as tools to reduce variation and improve clinical outcomes in performance-improvement initiatives. The aim of this study is to examine, in a family medicine residency practice, the effect of incorporating education about clinical practice guidelines for specific medical conditions and services on specific quality of care indicators.
An educational intervention regarding the implementation of clinical practice guidelines and the use of quality indicators for selected disease states or medical services was developed and implemented into a family medicine residency program. Residents completed a review of the records of selected patients who either were affected by the selected medical condition or were eligible for the medical service being provided, before and after participating in a specific seminar addressing guidelines addressing that condition.
Based upon the comparison between the chart reviews, some quality indicators significantly improved following the presentations (ie, documentation of oral examination in children and in patients with chronic illnesses, attempts to decrease medications in patients with anxiety disorders, compliance with measuring HgbA1C in patients with diabetes mellitus), while others did not.
The effect of an organized approach through presentation and chart review of specific quality indicators regarding medical problems frequently encountered in family medicine had a modest and inconsistent effect on the practice behaviors of family medicine residents.
临床实践指南作为一种工具，在绩效改进计划中有助于减少差异并改善临床结果。本研究的目的是在家庭医学住院医师培训实践中，检验针对特定医疗状况和服务纳入临床实践指南教育对特定医疗质量指标的影响。
针对选定疾病状态或医疗服务制定并实施了一项关于临床实践指南实施及质量指标使用的教育干预措施，并将其纳入家庭医学住院医师培训项目。住院医师在参加针对特定状况指南的特定研讨会之前和之后，对选定的受所选医疗状况影响或符合所提供医疗服务条件的患者记录进行了回顾。
根据图表回顾之间的比较，一些质量指标在讲座后有显著改善（即儿童和慢性病患者的口腔检查记录、焦虑症患者减少用药的尝试、糖尿病患者糖化血红蛋白测量的依从性），而其他指标则没有。
通过展示和图表回顾针对家庭医学中常见医疗问题的特定质量指标的有组织方法，对家庭医学住院医师的实践行为产生了适度且不一致的影响。
