Oxman A D, Thomson M A, Davis D A, Haynes R B
Health Services Research Unit, National Institute of Public Health, Oslo, Norway.
CMAJ. 1995 Nov 15;153(10):1423-31.
To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes.
MEDLINE, SCISEARCH, CINAHL and the Research and Development Resource Base in CME were searched for trials of educational interventions in the health care professions published between 1970 and 1993 inclusive.
Studies were selected if they provided objective measurements of health professional performance or health outcomes and employed random or quasi-random allocation methods in their study designs to assign individual subjects or groups. Interventions included such activities as conferences, outreach visits, the use of local opinion leaders, audit and feedback, and reminder systems.
Details extracted from the studies included the study design; the unit of allocation (e.g., patient, provider, practice, hospital); the characteristics of the targeted health care professionals, educational interventions and patients (when appropriate); and the main outcome measure.
The inclusion criteria were met by 102 trials. Areas of behaviour change included general patient management, preventive services, prescribing practices, treatment of specific conditions such as hypertension or diabetes, and diagnostic service or hospital utilization. Dissemination-only strategies, such as conferences or the mailing of unsolicited materials, demonstrated little or no changes in health professional behaviour or health outcome when used alone. More complex interventions, such as the use of outreach visits or local opinion leaders, ranged from ineffective to highly effective but were most often moderately effective (resulting in reductions of 20% to 50% in the incidence of inappropriate performance).
There are no "magic bullets" for improving the quality of health care, but there are a wide range of interventions available that, if used appropriately, could lead to important improvements in professional practice and patient outcomes.
确定不同类型干预措施在改善卫生专业人员绩效和健康结局方面的有效性。
检索MEDLINE、SCISEARCH、CINAHL以及继续医学教育研发资源库，查找1970年至1993年（含）期间发表的关于卫生保健专业教育干预措施的试验。
如果研究提供了卫生专业人员绩效或健康结局的客观测量指标，并且在研究设计中采用随机或准随机分配方法来分配个体受试者或组，则选择这些研究。干预措施包括会议、外展访问、利用当地意见领袖、审核与反馈以及提醒系统等活动。
从研究中提取的详细信息包括研究设计；分配单位（如患者、提供者、医疗机构、医院）；目标卫生保健专业人员、教育干预措施和患者（如适用）的特征；以及主要结局指标。
102项试验符合纳入标准。行为改变领域包括一般患者管理、预防服务、处方实践、高血压或糖尿病等特定疾病的治疗以及诊断服务或医院利用情况。仅传播策略，如会议或主动邮寄材料，单独使用时对卫生专业人员行为或健康结局几乎没有或没有影响。更复杂的干预措施，如外展访问或利用当地意见领袖，效果从无效到非常有效不等，但最常见的是中等有效（使不适当行为的发生率降低20%至50%）。
改善医疗质量没有“万灵药”，但有多种干预措施可供选择，如果使用得当，可显著改善专业实践和患者结局。
