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RIGHTSTEPS 计划:继续医学教育对慢性心力衰竭患者最佳药物治疗实践的影响。

The RightSTEPS initiative: Continuing education impact on clinicians' optimal medical therapy practices for chronic heart failure.

机构信息

Haymarket Medical Education, Paramus, NJ, USA.

American College of Cardiology, Washington, DC, USA.

出版信息

Med Teach. 2021 Feb;43(2):208-215. doi: 10.1080/0142159X.2020.1841126. Epub 2020 Nov 4.

Abstract

PURPOSE

Despite the existence of expert recommendations that can improve morbidity and mortality, reduce the need for hospitalization or readmission, and enhance quality of life in patients with heart failure (HF), many patients do not receive optimal medical therapy (OMT). The goal of this initiative, titled RightSTEPS, was to help physicians take the right steps to apply-evidence-based HF management strategies in clinical practice.

METHODS

Using the PRECEDE-PROCEED Model aimed at improving the clinical behavior of the learner, the instructional design featured 23 online and live face-to-face activities offering up to 16 credit hours of CME/CNE credit. These activities were delivered sequentially in three phases: predisposing, enabling and reinforcing. The lessons provided concise, pragmatic, stepwise management strategies aimed at empowering clinicians to prescribe evidence-based, guideline-directed OMT for patients with HF.

RESULTS

The predisposing and reinforcing online activities within the initiative reached a total of 71,510 learners with 23,902 successfully completed activities and post-tests; the enabling face-to-face activities reached a total audience of 763 clinicians. This initiative resulted in a statistically significant ( < 0.0001) increase in knowledge and competence related to HF OMT among the clinician learners. Furthermore, follow-up surveys indicated a commitment from learners to implement these guideline-directed strategies in their clinical practice.

CONCLUSIONS

This initiative demonstrated that the design of the RightSTEPS curriculum, using the Precede-Proceed model with sequentially-delivered, blended learning, provides a methodological framework to help learners translate knowledge into improvements in clinical behavior with the potential to improve patient health outcomes.

摘要

目的

尽管存在可以改善发病率和死亡率、减少住院或再入院需求以及提高心力衰竭 (HF) 患者生活质量的专家建议,但许多患者并未接受最佳药物治疗 (OMT)。这项名为 RightSTEPS 的计划旨在帮助医生采取正确的步骤,将基于证据的 HF 管理策略应用于临床实践。

方法

该计划采用旨在改善学习者临床行为的 PRECEDE-PROCEED 模型,其教学设计包括 23 个在线和面对面的现场活动,提供多达 16 个 CME/CNE 学分。这些活动分三个阶段顺序进行:前置、赋能和强化。课程提供简洁、务实、逐步的管理策略,旨在使临床医生能够为 HF 患者开出基于证据的、指南指导的 OMT。

结果

该计划中的前置和强化在线活动共覆盖了 71510 名学习者,其中 23902 人成功完成了活动和后测;赋能面对面活动共覆盖了 763 名临床医生。该计划导致与 HF OMT 相关的知识和能力在临床学习者中显著增加(<0.0001)。此外,后续调查表明学习者承诺将这些基于指南的策略应用于临床实践。

结论

该计划表明,RightSTEPS 课程的设计使用了 Precede-Proceed 模型,采用顺序交付的混合学习方法,为帮助学习者将知识转化为临床行为的改善提供了一个方法框架,从而有可能改善患者的健康结果。

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