ImaginationLancaster, UK.
HERD. 2011 Summer;4(4):12-33. doi: 10.1177/193758671100400403.
To investigate the connections between, and respective contributions of, evidence-based and experience-based methods in the redesign of healthcare services.
Evidence-based medicine (EBM) preceded (and inspired) the development of evidence-based design (EBD) for healthcare facilities. A key feature of debate around EBM has been the question of interpretation of the guidance by experienced clinicians, to achieve maximum efficacy for individual patients. This interpretation and translation of guidelines-avoiding a formulaic approach, allowing for divergent cultural and geographical exigencies, creating innovative, context-specific solutions-is the subject of this discussion, which examines the potential for integration of evidence-based and experience-based approaches in the development of creative solutions to healthcare services in England. This paper examines Practice-Based Commissioning (PBC) in England, which devolves responsibility for commissioning new services for patients to frontline clinicians, relying on their understanding of patient needs at the local level.
An 18-month project, funded by the Health and Care Infrastructure Research and Innovation Centre (HaCIRIC), examined PBC frameworks in England, investigating the impact of different models of governance on the development of service redesign proposals to answer the following questions: How do clinicians interpret the multiplicity of guidance from government agencies and translate this into knowledge that can be effectively used to redesign patient care pathways aligned with local healthcare priorities? How can understanding patient and staff "experiences" and key "touch points" of interaction with local healthcare services be used to provide a creative, customized solution to the design of healthcare services in a local, community-based framework?
探讨循证方法和经验方法在医疗服务重新设计中的联系和各自的贡献。
循证医学（EBM）先于（并启发）医疗设施的循证设计（EBD）的发展。围绕 EBM 的辩论的一个关键特征是经验丰富的临床医生对指导的解释问题，以实现对个体患者的最大疗效。本讨论探讨了避免公式化方法、允许不同文化和地理需求、创造创新、特定于上下文的解决方案的指南的解释和翻译，该讨论考察了在英格兰医疗服务的创造性解决方案的发展中整合循证和经验方法的潜力。本文考察了英格兰的基于实践的委托（PBC），该委托将为患者提供新服务的责任下放给一线临床医生，依靠他们在当地一级对患者需求的理解。
由健康与护理基础设施研究与创新中心（HaCIRIC）资助的一个为期 18 个月的项目，考察了英格兰的 PBC 框架，调查了不同治理模式对服务重新设计提案发展的影响，以回答以下问题：临床医生如何解释来自政府机构的多种指导，并将其转化为可有效用于重新设计与当地医疗保健重点一致的患者护理路径的知识？如何利用对患者和员工“体验”以及与当地医疗保健服务的关键“接触点”的理解，为基于社区的本地医疗服务设计提供创造性、定制的解决方案？
