一个机器学习框架,通过模拟临床轨迹和有针对性的干预措施来优化肥胖护理.
Jacob Nudel1, Kelly M Kenzik1, Iniya Rajendran2
1Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
Obesity (Silver Spring, Md.)
|October 16, 2023
概括
识别减肥手术 (WLS) 的瓶是增加获取机会的关键. 这项研究发现了显著的磨损点和风险因素,表明干预措施可以促进WLS程序.
科学领域:
- 腹部外科 腹部外科
- 肥胖管理 肥胖管理
- 医疗保健系统分析 医疗保健系统分析
背景情况:
- 减肥手术 (WLS) 是对肥胖的有效治疗方法,但其利用仍然不够理想.
- 临床管理途径存在瓶,阻碍患者向WLS发展.
- 了解消耗风险对于改善对减肥手术的准入至关重要.
研究的目的:
- 确定临床管理中的关键瓶,导致体重减轻手术 (WLS) 的使用不足.
- 评估与WLS途径每个阶段的消耗相关的患者特异性风险因素.
- 评估旨在优化WLS推流程的干预措施的潜在影响.
主要方法:
- 开发一个多状态概念模型,绘制患者从初级保健到WLS的进展.
- 分析2016-2017年期间由初级保健提供者 (PCP) 看到的符合条件的成年人队列 (n=5876).
- 使用Kaplan-Meier估计来确定通过定义护理状态的进展的2年结果.
主要成果:
- 从最初的PCP访问开始,两年的WLS率仅为1.0% (69/5876名患者).
- 显著的消耗发生在多个阶段,包括PCP访问 (35%),内分泌转诊 (15.6%),内分泌访问 (6.3%) 和WLS转诊 (4.7%).
- 女性性别,年龄较小,BMI较高,以及受训人员的照顾与增加的进展有关;提供者推实践有显著的差异.
结论:
- 体重减轻手术的低率是由临床管理途径中的特定,可识别的瓶驱动的.
- 开发的方法允许对干预措施进行in silico测试,以优化肥胖护理并增加WLS利用率.
- 有针对性的干预措施,如增加PCP转诊,可以显著增加WLS手术的数量.
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