在适应? 强迫搬迁后的医生实践风格
Alice J Chen1, Michael R Richards2, Rachel Shriver3
1Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.
新生儿分娩的医生治疗决策受到医院规范的高度影响. 当产科医生转移到具有较少侵入性实践的医院时,他们对新生儿分娩的方法变得不那么激进,改善了结果.
科学领域:
- 产科和妇科 产科和妇科
- 医疗保健服务研究 医疗服务研究
- 医疗决策 - - 医疗决策
背景情况:
- 医生的治疗决定显著影响母亲和婴儿的结果.
- 了解医院级规范对临床实践的影响对于改善医疗保健质量至关重要.
研究的目的:
- 研究医生对新生儿分娩的治疗决策的变化如何受到医院级产科临床决策规范变化的影响.
- 评估医院实践模式的转变对医生对新生儿分娩干预行为的影响.
主要方法:
- 使用差异差异方法分析佛罗里达州 (2003-2017) 所有医院分娩.
- 从产科单位关闭到将医生转移到具有不同分娩护理规范的医院的外部变化.
- 与安慰剂日期 (对照) 周围的医生在关闭 (治疗) 之前和之后连续观察的医生进行了比较.
主要成果:
- 由于关闭单位而搬迁的医生在他们的新医院采用了不那么激进的新生儿分娩做法.
- 观察到11个百分点 (33%) 的统计学上显著的新生儿在没有程序的情况下分娩的增加,随着时间的推移而持续.
- 医生付费者和患者组合保持不变,表明行为变化是由实践规范驱动的.
结论:
- 新生儿分娩护理中的医生行为是可塑的,并且对当前的医院实践模式敏感.
- 促进适当的临床护理规范的全医院政策可以显著改善医生决策,并有利于孕产妇和婴儿的结果.
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