Provider Training and Education in Disease Management: Current and Innovative Technology

Disease management has emerged as an important tool to increase quality of care, improve patient outcomes and control costs. Reducing provider practice variation is a key aspect of successful disease management. Clinical practice guidelines are a useful tool to reduce practice variation but are often underutilized. Provider training interventions, particularly using multiple educational strategies, have been proven to be effective in increasing guideline adherence. For maximal effect, provider training must also be combined with system interventions to support and sustain new provider behaviors. Educational technologies encompass electronic-based delivery methods and innovations in instructional design such as adult education, problem-based learning, and competency-based training. Innovations in educational technology are lowering common barriers to provider training such as limited provider time, less provider acceptance of traditional classroom methods and limited organizational training resources. Electronic technologies are central to delivery of distance learning, which uses technology to link instructors separated from learners by time and/or distance. Distance learning includes synchronous methods (which link learners who are separated by geographic distance but allow for simultaneous interaction) and asynchronous methods (which allow for interaction at different times). The range of electronic technologies include relatively simple and inexpensive methods requiring minimal infrastructure such as audio or videotape instruction, to technology--intensive methods such as videoconferencing or telemedicine, involving substantial infrastructure. Computer-assisted learning methods range from simple freestanding programs, to more sophisticated interactive Internet-based instruction, to highly sophisticated and realistic patient simulators. Constraints to implementing innovative educational technologies include providers' discomfort with electronic technology, increased time and cost of instructor-intensive face-to-face instructional methods and the requirement for extensive infrastructure and technical support of some electronic-based technologies. Selecting appropriate educational technology for disease management provider training requires careful consideration of both program and provider characteristics. More research is needed on the comparative effectiveness, synergies, limitations and health economics of innovative educational technologies in provider training.