使用行为经济学来减少老年人低价值护理:一个集群随机临床试验
Jeffrey T Kullgren1,2,3,4,5, H Myra Kim1,3, Megan Slowey6
1Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
JAMA internal medicine
|January 29, 2024
概括
这项研究发现,承诺明智选择干预措施减少了老年人低价值护理,并增加了糖尿病药物减强. 进一步的研究应该探索可扩展的干预措施,以提高医疗保健价值.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 行为经济学是一种行为经济学.
- 老年医学 老年医学
背景情况:
- 低价值护理在老年人中普遍存在,需要有效的减少护理策略.
- 让临床医生和患者参与,对于减少低价值服务的使用至关重要.
研究的目的:
- 评估承诺明智选择行为经济干预措施在减少低价值护理方面的有效性.
- 评估临床医生和患者的参与,减少老年人常见疾病的低价值服务.
主要方法:
- 在8个初级保健诊所进行了一项阶梯集群随机临床试验.
- 该干预涉及临床医生承诺选择明智的建议,并获得支持性材料,患者获得教育手册.
- 测量结果包括患者数月的低价值服务和针对特定疾病的药物减强.
主要成果:
- 干预显著减少了整体低价值护理 (调整后的几率比,0.79;95% CI,0.65-0.97).
- 观察到糖尿病低血糖药物的减强显著增加 (调整后的几率比,1.85;95% CI,1.06-3.24).
- 在减少失眠,焦虑或前列腺癌查的低价值护理方面没有发现显著差异.
结论:
- 承诺明智选择的干预措施有效地减少了在多个临床情景中低价值的护理.
- 该干预成功促进了糖尿病的药物减强,突出了其改善护理价值的潜力.
- 可扩展,基于推动的干预措施尊重患者和临床医生的自主权,需要进一步调查以提高医疗保健价值.
相关概念视频
01:24Operant Conditioning Intervention
57
Operant conditioning serves as a foundational principle in therapeutic interventions aimed at modifying maladaptive behaviors. Central to this approach is the notion that behaviors, both adaptive and maladaptive, are learned through reinforcement. By analyzing the environmental factors that reinforce problematic behaviors, clinicians can design interventions to weaken these reinforcements and replace maladaptive behaviors with healthier alternatives.
In operant conditioning, behaviors that are...
In operant conditioning, behaviors that are...
57
01:21Behavior Modification
160
Behavioral approaches have often been criticized for ignoring mental processes and focusing solely on observable behavior. However, these approaches provide an optimistic perspective for individuals seeking to change their behaviors. Rather than concentrating on intrinsic personality traits, behavioral approaches suggest that even longstanding habits can be modified by changing the reward contingencies that maintain them.
A real-world application of operant conditioning principles is applied...
A real-world application of operant conditioning principles is applied...
160
01:52Regression Toward the Mean
6.3K
Regression toward the mean (“RTM”) is a phenomenon in which extremely high or low values—for example, and individual’s blood pressure at a particular moment—appear closer to a group’s average upon remeasuring. Although this statistical peculiarity is the result of random error and chance, it has been problematic across various medical, scientific, financial and psychological applications. In particular, RTM, if not taken into account, can interfere when...
6.3K
01:29Issues And Trends In Healthcare Delivery System
5.6K
The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
5.6K
01:26Methods Of Healthcare Delivery System
3.3K
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
3.3K
02:45Self-Discrepancy Theory
18.3K
One influential perspective on what motivates people's behavior is detailed in Tory Higgin's self-discrepancy theory (Higgins, 1987). He proposed that people hold disagreeing internal representations of themselves that lead to different emotional states.
18.3K