Farias Michael, Ziniel Sonja, Rathod Rahul H, Friedman Kevin G, Colan Steven, Newburger Jane W, Fulton David R
Department of Medicine, Program for Patient Safety and Quality Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Congenit Heart Dis. 2011 Nov-Dec;6(6):558-65. doi: 10.1111/j.1747-0803.2011.00579.x. Epub 2011 Oct 17.
Despite the growing importance of clinical guidelines, their adoption has encountered significant resistance among clinicians. We developed Standardized Clinical Assessment and Management Plans (SCAMPs) as an innovative, clinician-led approach to building, implementing, and constantly improving flexible guidelines. We hypothesized that SCAMPs would fit well within the culture of medicine and that clinicians would therefore prefer SCAMPs over other guidelines.
We implemented an anonymous, computer-based survey to analyze provider attitudes toward SCAMPs at our institution.
Sixty-nine providers completed the questionnaire (73% response rate). Most providers reported a positive opinion about SCAMPs along axes of overall familiarity (83%), trust (91-94%), utility (75-87%), and overall attitude (64%). Fewer providers felt familiar with the SCAMP improvement process (60% neutral to unfamiliar) or knew that they played a role in this process (62% said no or unsure). Sixty-five percent reported experiencing an erosion in their autonomy with SCAMPs; when comparing this to other guidelines, 38% said other guidelines erode more, 26% felt SCAMPs erode more, and 36% were neutral. The plurality of providers chose SCAMPs as their preferred means to incorporate evidence-based medicine into their practice (46% vs 29% for clinical practice guidelines, 25% for other guidelines).
Providers look upon SCAMPs favorably and believe that SCAMPs successfully address numerous barriers to guideline adoption. Furthermore, SCAMPs are the preferred means to incorporate evidence-based medicine into practice among providers surveyed. SCAMPs may represent an important step in building guidelines that fit into the culture of medicine, obtain clinician "buy-in," and better influence clinical decision making.
尽管临床指南的重要性日益凸显，但其在临床医生中推行时却遭遇了巨大阻力。我们制定了标准化临床评估与管理计划（SCAMPs），这是一种由临床医生主导的创新方法，用于构建、实施并持续改进灵活的指南。我们推测SCAMPs将很好地融入医学文化，因此临床医生会比其他指南更青睐SCAMPs。
我们开展了一项基于计算机的匿名调查，以分析我院医护人员对SCAMPs的态度。
69名医护人员完成了问卷（回复率为73%）。大多数医护人员对SCAMPs在总体熟悉度（83%）、信任度（91 - 94%）、实用性（75 - 87%）和总体态度（64%）等方面给出了积极评价。较少医护人员熟悉SCAMP的改进过程（60%持中立或不熟悉态度），或者知道自己在这一过程中发挥了作用（62%表示不知道或不确定）。65%的人表示采用SCAMPs后自主权受到了削弱；与其他指南相比，38%的人认为其他指南对自主权的削弱更大，26%的人觉得SCAMPs对自主权的削弱更大，36%的人持中立态度。多数医护人员选择SCAMPs作为将循证医学纳入其临床实践的首选方式（46%，而选择临床实践指南的为29%，选择其他指南的为25%）。
医护人员对SCAMPs评价良好，并认为SCAMPs成功克服了指南推行中的诸多障碍。此外，在接受调查的医护人员中，SCAMPs是将循证医学纳入临床实践的首选方式。SCAMPs可能代表了构建符合医学文化、获得临床医生认可并更好地影响临床决策的指南的重要一步。
