在临床实践中,医疗保险授权的左心房关闭的共享决策
David H Howard1, Neal W Dickert2,3, Faisal M Merchant4
1Department of Health Policy and Management, Emory University, Atlanta, Georgia, USA.
Journal of cardiovascular electrophysiology
|August 9, 2024
概括
近40%的左心房尾关闭中心使用植入医生进行必要的共享决策,往往使患者和提供者承担负担. 需要改善医疗保险和医疗补助服务中心的指导,以便更好地调整政策.
科学领域:
- 心脏病学 心脏病学
- 卫生政策 卫生政策
- 医学伦理 医学伦理
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 在左心房附属器关闭 (LAAC) 之前,要求与独立的医生共同决策 (SDM).
- 了解这种SDM要求的临床实施对于患者护理和政策遵守至关重要.
研究的目的:
- 调查CMS授权的SDM交互如何在LAAC执行中心的临床实践中实施.
- 在LAAC程序之前评估医生和患者对SDM要求的观点.
主要方法:
- 一项调查分发给执行LAAC的中心.
- 通过使用2017年CMS服务提供商文件数据,对调查对象和非调查对象的医院特征进行了比较.
主要成果:
- 32%的受访中心做出了回应 (269个中86个).
- 植入医生在39.5%的响应中心进行了SDM交互,这与CMS政策相反.
- 61%的受访者认为SDM要求是负面的,理由是患者和提供者的负担;只有39%的人报告了积极或混合的经验.
结论:
- 很大一部分LAAC中心不遵守CMS政策,要求SDM需要独立的医生.
- 许多医疗保健提供者和患者认为SDM要求是繁重的.
- 需要CMS的明确指导,以确保政策的意图在临床实践中得到满足.
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