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to Practice Even Docs (and Nurses and PAs and 实践研究(甚至医生护士和PAS和课件
Research to Practice:Turning What We Know into What We Do Dana Best, MD, MPH, FAAP The Smoke Free Project Children’s National Medical Center, Washington, DC Strong Evidence Clinicians should counsel all tobacco users to quit First edition of Treating Tobacco Use and Dependence published in 1996 Few clinicians counsel!! Why Not? Why Not? Why Not? Why Not? Why Not? Why Not? Why Not? Why Not? Why Not? Why Not? Why Not? Why Not? What Can Be Done? Change Policy Implement policies that support counseling Reimbursement (carrot) Quality measures (both carrot and stick) Change Practice Training Quality improvement methods for clinical practice change Increase demand for counseling services Policy First…it’s actually easier to change policy than to change human (i.e., clinician) behavior… Policies Can Change Culture Clean air Cost Social norms National Policies Evidence Treating Tobacco Use and Dependence Recommendations American Academy of Pediatrics, American Academy of Family Practice, Society for Adolescent Medicine, many others Quality Measures NCQA Joint Commission Federal Support Electronic health records Medicare policies and funding Quit lines Patient and clinician resources AHRQ, etc. Veteran’s Administration Military and tobacco State Clean air Litter Insurance regulations Medicaid policy Health care licensing Facilities Individuals Local Access to resources for patients and families Enforcement of clean air regulations, licensing, etc. Policy Frontiers Coding for tobacco use Even in the child and adolescent healthcare setting Reimbursement follows At least we hope it does! Changing the Way Clinicians Practice A Brief History… Variations in practice noted Clinical guidelines will solve the problem! David Eddy, Mark Chassin No, they won’t! It’s the doctors – they need to be pushed It’s the system – it needs to be changed It’s the guidelines – they need to be disseminated Measurement More outcomes based Potentially punitive E.g. the surgeon who takes all the “toug
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