Rocker Graeme M, Verma Jennifer Y
.
Clin Invest Med. 2014 Oct 4;37(5):E311-9.
The well-documented gaps between needed and provided care for patients and families living with chronic obstructive pulmonary disease (COPD) mandate changes to clinical practice. The multifaceted evidence-based INSPIRED COPD Outreach Program™ was first implemented in Halifax, Nova Scotia, Canada in 2010 (INSPIRED = Implementing a Novel and Supportive Program of Individualized care for patients and families living with REspiratory Disease) and undergoes ongoing evaluation. By enhancing patient confidence to manage their illness more effectively in their homes and communities, there has been a sustained and substantial reduction in facility-based care in comparison with patient care experience pre-INSPIRED. Sustaining and spreading a program recently designated a leading practice by Accreditation Canada, and especially modifying the program as new evidence emerges, requires integrating and modeling at the 'bedside' both evidence-based medicine ('doing the right things') and quality improvement ('doing them right'). In Canada, where COPD care gaps are common, a new pan-Canadian INSPIRED-based quality improvement program is supporting multidisciplinary healthcare teams to bridge the chasm between evidence and practice by working together to 'do the right things right' in COPD care.
慢性阻塞性肺疾病（COPD）患者及其家庭所需护理与实际得到的护理之间存在诸多记录详实的差距，这就要求改变临床实践。多方面基于证据的“激励COPD外展计划”™于2010年在加拿大新斯科舍省哈利法克斯首次实施（INSPIRED的含义为“为患有呼吸系统疾病的患者及其家庭实施新颖且支持性的个性化护理计划”），并在持续接受评估。通过增强患者在家庭和社区更有效管理自身疾病的信心，与实施“激励计划”之前的患者护理体验相比，机构护理有了持续且大幅的减少。维持并推广一个最近被加拿大认证机构指定为领先实践的计划，尤其是随着新证据的出现对该计划进行调整，需要在“床边”将循证医学（“做正确的事”）和质量改进（“正确地做事”）进行整合并形成模式。在加拿大，COPD护理差距普遍存在，一个基于“激励计划”的全新泛加拿大质量改进计划正在支持多学科医疗团队，通过共同努力在COPD护理中“正确地做正确的事”来弥合证据与实践之间的差距。
