在阿片类药物使用障碍住院患者的医疗记录中对提供者语言进行耻辱和肯定
Rachel Hirshman1, Shavone Hamilton2, Melissa Walker2
1School of Social Work, North Carolina State University, Raleigh, North Carolina, USA.
在阿片类药物使用障碍 (OUD) 患者的电子健康记录中,污名化语言比肯定语言更为常见. 解决这个问题需要改变提供者实践和医疗记录系统,以改善患者护理.
科学领域:
- 医疗信息学 医疗信息学
- 公共卫生 公共卫生
- 精神病学是一个精神病学.
背景情况:
- 医疗保健的污名化阻碍了阿片类药物使用障碍 (OUD) 的治疗机会,这是一种导致显著发病率和死亡率的疾病.
- 临床文档语言通过延续耻辱或积极的看法,影响患者的体验和未来的护理.
- "21世纪治疗法"允许患者在线访问其完整的医疗记录.
研究的目的:
- 调查医疗保健提供者在OUD住院患者的电子健康记录 (EHR) 中使用的耻辱和肯定语言的普遍性和性质.
- 分析长时间住院的阿片类药物使用障碍 (OUD) 患者的电子健康记录中的语言模式.
主要方法:
- 确定了一组48名OUD确诊患者和至少28天住院的队列.
- 两名编码人员独立审查了录取和解雇说明,以对耻辱和肯定语言进行审查,并每周举行会议以确保可靠性.
- 数据分析的重点是识别和量化EHR中偏见与支持性语言的实例.
主要成果:
- 在96份患者笔记中,共发现了434例污名化语言和47例肯定语言.
- 大约三分之一 (34%) 的污名化语言来自系统生成的领域,如下拉菜单和诊断代码.
- 大多数污名化语言是由医疗保健提供者直接撰写的.
结论:
- 污名化语言在住院OUD患者的EHR中明显超过了肯定语言,出现的频率是OUD患者的9倍.
- 减少耻辱需要采取双重方法:教育提供者使用语言,并实施对EHR系统和诊断代码的制度变革.
- 对电子病历接口和ICD编码的系统级修改对于减轻医疗记录中普遍存在的耻辱至关重要.
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