临床实践指南和多种并发性疾病的老年患者的护理质量:对绩效报酬的影响
Cynthia M Boyd1, Jonathan Darer, Chad Boult
1Division of Geriatric Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md, USA. cyboyd@jhmi.edu
JAMA
|August 11, 2005
概括
临床实践指南 (CPG) 可能会伤害多种健康状况的老年患者. 坚持CPG可能会导致不适当的护理和错误的激励,强调需要针对复杂的并发症量身定制的质量措施.
科学领域:
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
- 基于证据的实践.
背景情况:
- 临床实践指南 (CPG) 旨在提高慢性疾病的医疗保健质量.
- 按绩效支付的倡议往往将医生的表现与CPG的遵守联系起来.
研究的目的:
- 评估现有的CPG对管理多种并发性疾病的老年人护理的适用性.
主要方法:
- 分析医疗保险受益人中普遍存在的慢性疾病,并确定相关的CPG.
- 独立评估CPG适用于伴随疾病的老年患者,考虑治疗目标,药物相互作用,患者负担和偏好.
- 一个假设患有多种慢性疾病的患者的建议汇总.
主要成果:
- 大多数CPG都缺乏针对多种并发病的老年患者的具体指导,未能解决治疗目标,患者负担或偏好.
- 对于一个假设的患者来说,遵循CPG导致了12种药物和潜在的不良药物相互作用的复杂疗法.
- 发现了与处方药相关的每月显著的费用.
结论:
- 遵守当前的CPG可能会对具有复杂健康状况的老年人产生不良结果.
- 在这个群体中,使用现有的CPG进行质量评估和绩效支付可能会导致错误判断和不良激励.
- 制定针对多种并发症的老年患者护理的具体质量措施对于改善他们的医疗保健至关重要.
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