实施临床实践指南并改善 SLE 患者健康结果的多组分策略
实施临床实践指南和改善系统性红斑狼疮患者健康结果的多组分策略的有效性和成本效益
主要目标:产生关于知识转移和实施系统性红斑狼疮 (SLE) 临床实践指南 (CPG) 的有效性和成本效益的科学知识,该指南由教育干预、计算机化临床决策支持系统组成(SADC),辅之以内置于电子临床记录中的自动反馈。
次要目标将在之前制定:1) 分析加那利群岛卫生服务 (SCS) 中 SLE 患者护理的医疗实践变化; 2) 支持南共体最佳发展的最佳可用科学证据; 3) 南海创新实施的背景和障碍; 4) 制定实施策略的内容,包括 SADC 和自动反馈。
主要目标的方法:主要目标将在 SCS 的开放、多中心和随机(按集群)临床试验下进行评估。 多组分干预将与 CPG 传播的通常程序进行比较。 主要衡量标准是 SLAQ 量表评定的 SLE 自我感知活动。 将通过问卷 EQ-5D-5L 获得自我感知的健康相关生活质量 (HRQoL) 数据,以估算成本效益比。
次要目标的方法:其余目标将通过定量和定性研究方法的组合来制定,以使干预的设计、开发和执行适应环境的特征。
研究概览
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Santa Cruz de Tenerife、西班牙、38004
- Servicio de Evaluación del Servicio Canario de la Salud
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
纳入标准:
- 病人:
同意参与并签署知情同意书的成人(18 岁以上)被诊断患有任何严重程度和情况(活动、缓解或临床静止和血清活动)的 SLE。
- 卫生专业人员:
风湿病学或内科专业的医生在他们的配额中包括至少 30 名符合条件的 SLE 患者。
排除标准:
- 病人:
SLE 局限于皮肤、晚期慢性肾病(透析或肾移植);精神疾病和/或感觉或认知缺陷;或参与另一项 RCT 的扩展或后续研究(后续指南可能发生变化)。 观察性研究的参与者可能会被包括在内,因为他们不会改变通常的做法。
学习计划
研究是如何设计的?
设计细节
- 主要用途:卫生服务研究
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:多组分干预
风湿病学家和内科医生接受多组分干预
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对负责 SLE 患者护理的风湿病学家和内科医生进行干预。
实施多组件干预,包括:教育组件、根据临床实践指南开发的计算机化临床决策支持系统 - SLE 和集成到电子病历系统中的自动反馈。
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无干预:控制
风湿病学家和内科医生提供常规护理
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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SLE 自我感知活动的变化
大体时间:18个月
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患者使用系统性红斑狼疮活动度 (SLAQ) 问卷自我报告的疾病活动度
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18个月
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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专业人士对 SLE 管理知识的改变
大体时间:18个月
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通过专门设计的问卷评估获得的知识
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18个月
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自我感知的健康相关生活质量的变化
大体时间:18个月
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使用 EQ-5D-5L 问卷自我感知的健康相关生活质量
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18个月
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自我感知的健康相关生活质量的变化
大体时间:18个月
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使用 LupusQol 问卷自我感知的健康相关生活质量
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18个月
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患者对他们参与决策的看法
大体时间:18个月
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患者使用共同决策 (SDM-Q-9) 问卷对临床医生协助和决策过程的看法
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18个月
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专业人士对与患者合作共同决策的态度
大体时间:18个月
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Leeds Attitude Towards Concordance II 量表 (LATCon II) 评估的专业人士对共同决策的态度
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18个月
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专业人员对 CPG-SLE 建议的遵守
大体时间:18个月
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专业遵守建议的程度将通过临床记录的数据收集来确定,根据 SLE-CPG 的建议进行充分治疗的患者百分比
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18个月
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合作者和调查者
调查人员
- 首席研究员:María de Mar Trujillo Martin, PhD、Servicio de Evaluación del Servicio Canario de la Salud
出版物和有用的链接
一般刊物
- Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct 20;282(15):1458-65. doi: 10.1001/jama.282.15.1458.
- Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, Edwards A, Barry M. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012 Oct;27(10):1361-7. doi: 10.1007/s11606-012-2077-6. Epub 2012 May 23.
- Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012 May 31;7:50. doi: 10.1186/1748-5908-7-50.
- Serrano-Aguilar P, Kovacs FM, Cabrera-Hernandez JM, Ramos-Goni JM, Garcia-Perez L. Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study. BMC Musculoskelet Disord. 2011 Dec 21;12:287. doi: 10.1186/1471-2474-12-287.
- Ostbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005 May-Jun;3(3):209-14. doi: 10.1370/afm.310.
- Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009 Jul 8;2009(3):CD001096. doi: 10.1002/14651858.CD001096.pub2.
- Jacobs SR, Weiner BJ, Bunger AC. Context matters: measuring implementation climate among individuals and groups. Implement Sci. 2014 Apr 17;9:46. doi: 10.1186/1748-5908-9-46.
- Zhu TY, Tam LS, Li EK. Cost-of-illness studies in systemic lupus erythematosus: A systematic review. Arthritis Care Res (Hoboken). 2011 May;63(5):751-60. doi: 10.1002/acr.20410. Erratum In: Arthritis Care Res (Hoboken). 2011 Jul;63(7):1074.
- Lerang K, Gilboe IM, Gran JT. Differences between rheumatologists and other internists regarding diagnosis and treatment of systemic lupus erythematosus. Rheumatology (Oxford). 2012 Apr;51(4):663-9. doi: 10.1093/rheumatology/ker318. Epub 2011 Dec 7.
- Bertsias G, Ioannidis JP, Boletis J, Bombardieri S, Cervera R, Dostal C, Font J, Gilboe IM, Houssiau F, Huizinga T, Isenberg D, Kallenberg CG, Khamashta M, Piette JC, Schneider M, Smolen J, Sturfelt G, Tincani A, van Vollenhoven R, Gordon C, Boumpas DT; Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis. 2008 Feb;67(2):195-205. doi: 10.1136/ard.2007.070367. Epub 2007 May 15.
- Sidorenkov G, Haaijer-Ruskamp FM, de Zeeuw D, Denig P. A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness. PLoS One. 2011;6(9):e24278. doi: 10.1371/journal.pone.0024278. Epub 2011 Sep 8.
- Perez X, Wisnivesky JP, Lurslurchachai L, Kleinman LC, Kronish IM. Barriers to adherence to COPD guidelines among primary care providers. Respir Med. 2012 Mar;106(3):374-81. doi: 10.1016/j.rmed.2011.09.010. Epub 2011 Oct 13.
- Kastner M, Bhattacharyya O, Hayden L, Makarski J, Estey E, Durocher L, Chatterjee A, Perrier L, Graham ID, Straus SE, Zwarenstein M, Brouwers M. Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review. J Clin Epidemiol. 2015 May;68(5):498-509. doi: 10.1016/j.jclinepi.2014.12.013. Epub 2015 Jan 10.
- Francke AL, Smit MC, de Veer AJ, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008 Sep 12;8:38. doi: 10.1186/1472-6947-8-38.
- Sketris IS, Langille Ingram EM, Lummis HL. Strategic opportunities for effective optimal prescribing and medication management. Can J Clin Pharmacol. 2009 Winter;16(1):e103-25. Epub 2009 Jan 30.
- Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, Makosso-Kallyth S, Wolf FM, Farmer AP, Gagnon MP. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD004398. doi: 10.1002/14651858.CD004398.pub3.
- Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005470. doi: 10.1002/14651858.CD005470.pub2.
- Gillaizeau F, Chan E, Trinquart L, Colombet I, Walton RT, Rege-Walther M, Burnand B, Durieux P. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev. 2013 Nov 12;(11):CD002894. doi: 10.1002/14651858.CD002894.pub3.
- Murphy EV. Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success. Yale J Biol Med. 2014 Jun 6;87(2):187-97. eCollection 2014 Jun.
- Ramallo-Farina Y, Garcia-Perez L, Castilla-Rodriguez I, Perestelo-Perez L, Wagner AM, de Pablos-Velasco P, Dominguez AC, Cortes MB, Vallejo-Torres L, Ramirez ME, Martin PP, Garcia-Puente I, Salinero-Fort MA, Serrano-Aguilar PG; INDICA team. Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients--the INDICA study: a cluster randomized controlled trial. Implement Sci. 2015 Apr 9;10:47. doi: 10.1186/s13012-015-0233-1.
- Roshanov PS, Fernandes N, Wilczynski JM, Hemens BJ, You JJ, Handler SM, Nieuwlaat R, Souza NM, Beyene J, Van Spall HG, Garg AX, Haynes RB. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ. 2013 Feb 14;346:f657. doi: 10.1136/bmj.f657.
- Lobach D, Sanders GD, Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux R, Samsa G, Hasselblad V, Williams JW, Wing L, Musty M, Kendrick AS. Enabling health care decisionmaking through clinical decision support and knowledge management. Evid Rep Technol Assess (Full Rep). 2012 Apr;(203):1-784.
- Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014 Oct 1;312(13):1295-6. doi: 10.1001/jama.2014.10186. No abstract available.
- Serrano-Aguilar P, Trujillo-Martin Mdel M, Perez de la Rosa A, Cuellar-Pompa L, Saavedra-Medina H, Linertova R, Perestelo-Perez L, Perez-Ramos J, Rivero-Santana A; Spanish SLE CPG Development Group. Patient participation in a Clinical Guideline Development for Systemic Lupus Erythematosus. Patient Educ Couns. 2015 Sep;98(9):1156-63. doi: 10.1016/j.pec.2015.05.022. Epub 2015 Jun 11.
- Politi MC, Wolin KY, Legare F. Implementing clinical practice guidelines about health promotion and disease prevention through shared decision making. J Gen Intern Med. 2013 Jun;28(6):838-44. doi: 10.1007/s11606-012-2321-0. Epub 2013 Jan 10.
- Loya SR, Kawamoto K, Chatwin C, Huser V. Service oriented architecture for clinical decision support: a systematic review and future directions. J Med Syst. 2014 Dec;38(12):140. doi: 10.1007/s10916-014-0140-z. Epub 2014 Oct 18.
- Panzarasa S, et al.Technical Solutions for Integrating Clinical Practice Guidelines with Electronic Patient Records. Volume 5943 of LNAI. Springer-Verlag 2010;141 -154
- Kawamoto K, Del Fiol G, Orton C, Lobach DF. System-agnostic clinical decision support services: benefits and challenges for scalable decision support. Open Med Inform J. 2010;4:245-54. doi: 10.2174/1874431101004010245. Epub 2010 Dec 14.
- Trujillo-Martin MM, Ramallo-Farina Y, Del Pino-Sedeno T, Rua-Figueroa I, Trujillo-Martin E, Vallejo-Torres L, Imaz-Iglesia I, Sanchez-de-Madariaga R, de Pascual-Medina AM, Serrano-Aguilar P; SLE-CPG-Implementation Group. Effectiveness and cost-effectiveness of a multicomponent intervention to implement a clinical practice guideline for systemic lupus erythematosus: protocol for a cluster-randomized controlled trial. BMC Health Serv Res. 2019 Nov 1;19(1):783. doi: 10.1186/s12913-019-4589-9.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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多组分干预的临床试验
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University of Illinois at ChicagoShirley Ryan AbilityLab; Oakland University; Access Living主动,不招人
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University of Wisconsin, MadisonNational Cancer Institute (NCI); Northwestern University主动,不招人