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Therapeutic behavior management (TBM) is a technology for creating a clinical environment that brings out the best in staff while generating the highest possible compliance outcomes for patients. The techniques and practices of TBM are derived from the field of applied behavior analysis, the term describing the scientific study of behavior. The field of applied behavior analysis was clearly defined by Baer, Wolf, and Risley (1968).〔Baer, D.M., Wolf, M.M., & Risley, T.R., (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.〕 Its subject matter is human behavior: why we act as we do, how we acquire habits, and how we lose them or change them, if change is needed. TBM is a branch of performance management that focuses on improving patient outcomes through improved compliance. To understand behavior, behavior analysts use the same scientific methods that the physical sciences employ: precise definition of the behavior under study, experimentation, and consistent replication of the experimental findings. Basic research in this area has been conducted for over a century, however, applied research has been conducted only since the 1950s. Business, industrial, and government applications began in the late 1960s. ==Purpose== That non-compliance represents a threat to the future of patients and providers is demonstrated by the disastrous statistics related to direct costs, over use of the system, unnecessary health service provided, and needless deaths (125,000 in the US per year).〔Balkrishnan R, Rajagopalan R, Camacho FT, et al. Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study. Clin Ther. 2003;25:2958–71〕 Adherence to long-term therapies: evidence for action.〔Geneva: World Health Organization. ISBN 92-4-154599-2〕 Counseling and education models developed over the years to improve patient understanding and compliance have failed to move the needle.〔Bond WS, Hussar DA. Detection methods and strategies for improving medication compliance.Am J Hosp Pharm. 1991;48:1978–88.〕 These models have been time tested and on the surface are straight forward, consistent, and logical. In spite of their clear appeal to ''“common sense”'' they are also not terribly effective.〔Bartlett EE, Grayson M, Barker R, et al. The effects of physician communications skills on patient satisfaction; recall, and adherence. J Chronic Dis. 1984;37:755–64.〕〔Berghofer G, Schmidl F, Rudas S, et al. Predictors of treatment discontinuity in outpatient mental health care. Soc Psychiatry Psychiatr Epidemiol. 2002;37:276–82. ()〕 Compliance today is about the same as it was in the middle of the 5th century and in the US it is the same as in any other first world country. The Affordable Care Act (2010)〔Pub.L. 111–148, 124 Stat. 119, to be codified as amended at scattered sections of the Internal Revenue Code and in 42 U.S.C.〕 will continue to unfold and patient behavior will have a significant impact of the bottom line of care. Providers who fall below an arbitrary quality line can expect to have Medicare revenue recouped based on outcomes of care and will begin to look for ways to mitigate their risks.〔http://jefflcohen.wordpress.com/2013/01/18/what-you-need-to-know-about-the-physician-feedback value-based-payment-modifier-program/〕〔http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Physician Feedback Program/Background.html〕 Developing and implementing a well-managed TBM program targeting the 50% who are non-compliant and working with them to change their behavior may represent the best path towards reducing risk. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Therapeutic behavior management」の詳細全文を読む スポンサード リンク
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