推动证据向临床转化(十六)从理论到实践:基于i-PARIHS模式的指南转化动态路径图

From theory to practice:Introduction of the dynamic pathway for guidelines implementation based on i-PARIHS model

目的基于i-PARIHS(Promoting action on research implementation in health services integrated framework)模式,构建临床实践指南转化和应用路径图。方法以“护士职业性腰背痛预防与护理临床实践指南转化研究”为例,以我国医疗政策环境为背景,以证据转化与临床应用的方法学为参考,围绕i-PARIHS模式的4个阶段,构建临床实践指南临床转化和应用的路径图。结果基于i-PARIHS模式的指南转化动态路径图,包括4个阶段,12个步骤,阐释了指南转化研究的具体过程,明确了相应的步骤内容、预期目标、侧重要素和方法学参考,同时强调了“促进者”在项目实施中的联结价值和驱动作用,并指出促进者和接受者之间需要双向反馈和互动机制。结论基于i-PARIHS模式的指南转化动态路径图,优化了原模式的实施流程,适合指导国内机构开展基于指南证据的循证实践。

Objective To develop an operational pathway for guidelines implementation based on i-PARIHS model.Methods According to the process of the translation research on Clinical practice guideline of Chinese nurses’occupational low back pain prevention and care,we developed a dynamic pathway for guidelines implementation which integrated the four phases of implementation study of i-PARIHS model with Chinese characteristics in terms of domestic medical policy and system,as well as methodologies of evidence translation and clinical implementation.Results The dynamic pathway consisted of four stages and 12 steps,which elaborated on the specific information of each stage and each step in terms of classifications,contents,aims,core elements involved and possible operational methodologies.In addition,the roles of different facilitators were also emphasized as liaisons and drivers in the process of guideline implementation.Mutual feedback and interactions were also warranted between recipients and facilitators throughout the process of guideline implementation.Conclusion The dynamic pathway optimizes the process of guidelines implementation,which can serve as a potential useful framework to implement evidence-based guidelines in Chinese context.