Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine.
Department of Pediatrics, Division of Biostatistics.
J Pediatr Gastroenterol Nutr. 2022 May 1;74(5):568-574. doi: 10.1097/MPG.0000000000003405.
Integrating continuing medical education and quality improvement (QI) initiatives is challenging. We aimed to compare one method, Interactive Spaced Education (ISE/QI), with standard (sTD/Qi) education embedded within a constipation management Qi initiative.
We conducted a randomized, controlled study to compare ISE/QI and STD/QI education. Pediatric primary care providers (PCPs) were recruited from a network of local private practices. The QI initiative was implemented with all providers before education interventions. ISE/QI participants received questions by email weekly, provided answers, received feedback, and repeated questions over a 4-month period. The STD/QI group received a Power Point with the same educational content. Pre- and post-surveys evaluated usability, self-assessed confidence, and practice changes while quizzes evaluated knowledge. Process control charts tracked subsequent visits to gastroenterology (GI).
Of the 212 eligible PCPs, 101 (48%) enrolled, with 49 PCPs in the ISE/QI arm and 52 in STD/QI education arm. Quiz scores improved in the ISE/QI arm with a strong effect size (Cohen d 1.76). Mean increase in confidence managing difficult cases was higher in the ISE/QI group (1.84 vs 1.21, P = 0.030). ISE/QI participants were more likely to rate the activity better than most online education (odds ratio [OR] 18.1, P < 0.0001) and incorporate practice changes (OR 3.35, P = 0.0152). Visits to GI decreased among the entire population, but the effect on GI visits within each education arm was mixed.
ISE/QI improved knowledge and confidence managing difficult cases. ISE/QI participants reported higher likelihood to change practice, but no differences were seen in GI referrals.
将继续医学教育和质量改进（QI）计划相结合具有挑战性。我们旨在比较一种方法，即互动间隔教育（ISE/QI）与嵌入便秘管理 QI 计划中的标准（sTD/Qi）教育。
我们进行了一项随机对照研究，以比较 ISE/QI 和 STD/QI 教育。儿科初级保健提供者（PCP）从当地私人诊所网络招募。在教育干预之前，所有提供者都实施了 QI 计划。ISE/QI 参与者每周通过电子邮件收到问题，提供答案，接收反馈，并在 4 个月内重复问题。sTD/QI 组收到了相同教育内容的 Power Point。预调查和后调查评估了可用性、自我评估的信心和实践变化，而测验则评估了知识。过程控制图跟踪随后的胃肠病学（GI）就诊。
在 212 名符合条件的 PCP 中，有 101 名（48%）参加了研究，其中 ISE/QI 组有 49 名 PCP，sTD/QI 教育组有 52 名。ISE/QI 组的测验分数有所提高，具有较强的效应量（Cohen d 1.76）。在处理困难病例方面，自我评估信心的平均提高幅度在 ISE/QI 组更高（1.84 与 1.21，P = 0.030）。ISE/QI 参与者更有可能认为该活动优于大多数在线教育（优势比 [OR] 18.1，P < 0.0001），并改变实践（OR 3.35，P = 0.0152）。尽管整个人群的 GI 就诊量都有所下降，但每个教育组的 GI 就诊量的影响则各不相同。
ISE/QI 提高了知识和处理困难病例的信心。ISE/QI 参与者报告更有可能改变实践，但在 GI 转诊方面没有差异。
