如何做出临床决策课件.pptxVIP

如何做出临床决策？How to Make Practice Decisions？田梅梅目的 Objectives罗列临床决策制定的组分 List the components of evidence-based decision making.讨论临床决策制定的步骤 Discuss the process of evidence‐based decision making.解释“投资回报”这个术语 Describe the term “return on investment”.探讨“投资回报”与循证实践项目的重要关系 Discuss the importance of ROI related to EBP projects.循证实践的步骤 EBP process临床问题Clinical Inquiry设计一个可以检索的、可以找到答案的问题Formulate a Searchable, Answerable Question (PICOT)寻找最佳证据Search for the Best Evidence快速实施证据的关键评价、评估与合并Rapid Critical Appraisal, Evaluation, and Synthesis of Evidence产生证据Generate Evidence 内部：质量改进QI外部：科学研究 Research结合临床专家意见与病人偏好整合证据Integrate the Evidence with Clinical Expertise and Patient Preference(s)评估证据应用的结果Evaluate Outcomes based on Evidence传播结果Disseminate the Outcome(s)决策 Decision对某个问题仔细考虑后的评判 The passing of judgment on an issue under consideration.得出结论或作出决定后的行动 The act of reaching a conclusion or making up ones mind.所获得的或明确的一个结论或判断，一个定论 A conclusion or judgment reached or pronounced; a verdict.不管是谁作的决策，或如何作出决策Regardless of who makes the decision, orhow the decision is made证据临床实践经验病人和家属注重的永远保持好奇心，因为知识不会来找你;你必须自己去寻求—苏狄.巴克Be curious always, for knowledge will not acquire you; you must acquire it.” —Sudie Black制定决策 Decision Making我们知道什么What We Know国际上应用的Intentionally applied知识Knowledge工具Tools经验 experience证据 Evidence循证实践模型或框架Model/Framework(EBP)外部证据：External Evidence科研Research标准Benchmarks临床工作者Clinician;个体与小组Individual and Group质量改进步骤 Quality ImprovementProcess? PDSA (Plan Do Study Act)?精益流程 Lean processes内部证据：Internal Evidence质量改进QI本科室资料unit-based data 病人和家属Patient and Family价值观与偏好Values and Preferences知识的正规来源Formalized Sources of Knowledge教育Education – 课堂Classroom – 临床Clinical证据 Evidence –效度Valid –信度Reliable –可行性Applicable知识Knowledge教育Education内部和外部证据Internal andExternal Evidence知识的实践来源Practical Sources of Knowledge临床经验Clinical Experience – 你个人的实践Your individual practice – 你小组的实践Your group practice –咨询同事与专家Queries to colleagues and experts病人经验Patient Experience –价值观与偏好 Values and preferences –病人与