在主要医疗系统中,临床医生使用静止剂选择共享决策碰撞工具
Kathryn A Martinez1, Victor M Montori2, Fatima Rodriguez3
1Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA. martink12@ccf.org.
Journal of general internal medicine
|January 9, 2024
概括
临床医生使用Statin Choice共享决策工具的总体水平较低,但根据患者的人口统计学 (如年龄,种族和性别) 显著变化,个人临床医生行为推动了工具采用的半数以上变化.
科学领域:
- 医疗信息学 医疗信息学
- 临床决策支持 临床决策支持
- 共享的决策方式
背景情况:
- 有效的共享决策 (SDM) 工具存在,但它们在临床实践中的实际实施在很大程度上仍未得到审查.
- 了解临床医生采用SDM工具对于改善以患者为中心的护理至关重要.
研究的目的:
- 调查在电子健康记录 (EHR) 工作流程中使用Statin Choice SDM工具的现实世界.
- 为了识别与使用这种他类药物相关的患者和临床医生因素,将提供处方决策的帮助.
主要方法:
- 一项横截面研究分析了2020年1月至2021年6月期间门诊接触的数据.
- 在Epic EHR系统中记录了临床使用Statin Choice工具的情况.
- 混合效应后勤回归评估了影响工具使用的因素,包括患者人口统计和心血管风险,临床医生水平的变化由ICC量化.
主要成果:
- 在68,505个符合条件的他类药物处方接触中,仅有7%使用了"他类药物选择"工具.
- 临床医生的使用情况各不相同,其中48%的临床医生至少为一名患者使用该工具.
- 患者年龄和动脉样硬化心血管疾病 (ASVCD) 风险与工具使用增加有关,而黑人种族和女性性别与使用减少有关.
结论:
- 在现实世界中,对Statin Choice SDM工具的采用是有限的.
- 患者的因素,包括种族和性别,影响了工具的使用.
- 个人临床医师的行为占了使用Statin Choice的53%的变化,突出显示了临床医师层面干预的重要性.
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