Alagoz Esra, Chih Ming-Yuan, Hitchcock Mary, Brown Randall, Quanbeck Andrew
Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792-1690, USA.
Department of Clinical Sciences, University of Kentucky College of Health Sciences, Room 209 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA.
BMC Health Serv Res. 2018 Jan 25;18(1):42. doi: 10.1186/s12913-018-2856-9.
External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings.
We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion.
Academic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes.
Our results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn't find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.
外部变革推动者在医疗保健组织变革努力中可发挥重要作用。本系统评价考察了外部变革推动者在旨在促进医疗保健领域（特别是基层医疗环境）组织变革的多方面干预措施背景下所发挥的作用。
我们于2016年7月在PubMed、CINAHL、Cochrane、科学网和学术搜索高级数据库中检索了2005年1月1日至2016年6月30日期间发表的（英文）随机试验，其中外部推动者是多方面组织变革策略的一部分。该评价按照PRISMA指南进行。两名作者共识别并筛选了477篇摘要。对113项研究的全文进行了审查。其中21项研究被选中纳入。
学术推广（AD）是作为多成分实施策略一部分使用最普遍的组织变革策略。在21项研究中，几乎所有研究都将某种形式的审核与反馈纳入其干预措施。11项在干预措施中纳入实践促进的研究报告了在一个或多个主要结局方面有显著效果。
我们的结果表明，定期进行量身定制的跟进的实践促进是成功的组织变革策略的有力组成部分。若没有密集跟进，单独的学术推广或仅与审核和反馈相结合都是无效的。提供教育材料以及使用审核和反馈通常是多方面实施策略的组成部分。然而，我们未找到这些相对有限的策略作为独立干预措施有效的实例。通过技术（如自动提醒或警报）提供系统层面的支持可能会有帮助，但必须仔细根据诊所需求进行定制。
Zotero 插件