患者和医疗保健组织因素与偶然结节指南的关联 遵守:多系统观察性研究
Christopher G Slatore1, Elizabeth R Hooker2, Sarah Shull2
1Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, and Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
放射科医生对肺结节指南的遵守率为69%,但只有48%的患者得到了与指南一致的随访. 医疗保健系统需要更好的工具,以确保对偶发性肺结节的患者进行适当的随访.
科学领域:
- 肺部医学 肺部医学
- 放射学 放射学是一门学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 医疗机构正在实施系统,以改善对肺结节的护理指南的遵守.
- 这项研究旨在确定影响放射科医生遵守和患者/临床医师符合2005年弗莱什纳学会关于偶发性肺结节后续监测指南的因素.
研究的目的:
- 确定与放射科医生遵守2005年弗莱什纳学会关于偶发性肺结节随访的指南相关的患者和组织因素.
- 评估临床医生和患者是否符合这些指南.
主要方法:
- 来自两家退伍军人事务医疗保健系统 (2008-2016) 的3150名偶发性肺结节患者的电子病历数据.
- 放射学报告和患者随访数据被分类为遵守和符合2005年弗莱什纳学会指南.
- 计算了多变量调整的预测概率,以确定相关因素.
主要成果:
- 69%的放射科医生建议符合指导方针;27%的放射科医生建议进行不那么激进的后续检查.
- 只有48%的患者进行了与指导方针一致的随访; 37%的患者进行了不那么积极的随访.
- 放射科医生坚持与临床医生/患者一致性有关,医疗保健系统作为潜在的修饰因素.
结论:
- 临床医生和患者通常遵循放射科医生的建议,但下游医疗保健系统的流程往往导致非一致的随访.
- 医疗机构需要强大的系统来确保肺结节患者的适当随访.
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