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首页> 外文期刊>Preventive Medicine: An International Journal Devoted to Practice and Theory >Facilitating practice change: lessons from the STEP-UP clinical trial.
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Facilitating practice change: lessons from the STEP-UP clinical trial.

机译：促进实践变更：STEP-UP临床试验的经验教训。

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BACKGROUND: The Study To Enhance Prevention by Understanding Practice (STEP-UP) clinical trial (1997-2000) resulted in sustainable increases in preventive service delivery in primary care practices. However, the process by which practice change can be facilitated has not been well described. METHODS: Comparative case studies were conducted of eight STEP-UP practices with the largest increases in preventive service delivery rates and compared to seven practices with the lowest increases. A multidisciplinary team (research nurse, nurse facilitator, physician principal investigator) used an editing analysis approach to create individual case studies. Then, using an immersion-crystallization approach, the team identified pragmatic lessons for people working to improve primary care practice, and validated these lessons with a participating practice and an additional facilitator. RESULTS: It is not always possible to predict which practices will change based on understanding initial practice conditions. "Malleable moments" can be identified during which practices become open to change. It is important to tie change strategies with existing motivations, or to develop new motivation among potential change agents. Motivation can be developed by discrepant information that challenges self-image, aligning change plans with existing values, or identifying feasible ways of responding to outside pressures or internal demands. Instrumental interventions (such as office systems, tools, new processes) are useful when motivation to change exists, and can build motivation when they meet a perceived need. Disruption in previously workable approaches, either by purposeful information seeking or unanticipated changes, promotes openness to change. CONCLUSIONS: Despite limited ability to predict which practices will change and when, understanding practices' initial conditions and evolution can identify opportunities to craft individualized approaches to positive change.
机译：背景：通过了解实践来加强预防的研究（STEP-UP）临床试验（1997-2000年）导致了初级保健实践中预防服务的可持续增长。然而，尚未很好地描述可以促进实践改变的过程。方法：比较案例研究是针对预防性服务交付率增长最大的八种逐步提高实践，而相比之下，增长最少的七种实践则进行了案例研究。一个多学科团队（研究护士，护士主持人，医师主要研究人员）使用编辑分析方法来创建个案研究。然后，该小组使用浸没-结晶方法，为致力于改善初级保健实践的人们确定了实用的课程，并通过参与实践和额外的协助者对这些课程进行了验证。结果：并非总是能够基于对初始实践条件的了解来预测哪些实践将会改变。在实践变得可以改变的过程中，可以识别出“重大时刻”。重要的是将变更策略与现有动机联系起来，或者在潜在的变更推动者之间发展新的动机。可以通过挑战自我形象的差异信息，使变更计划与现有价值保持一致或确定应对外部压力或内部需求的可行方式来开发动机。当存在改变的动力时，工具性干预（例如办公系统，工具，新流程）将非常有用，而当它们满足人们的感知需求时便可以建立动力。通过有目的的信息搜索或意料之外的更改而破坏了以前可行的方法，从而促进了更改的开放性。结论：尽管预测哪些实践将改变以及何时改变的能力有限，但了解实践的初始条件和演变仍可以发现机会，以个体化的方式来实现积极的改变。

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