在重症监护中整合健康的社会决定因素
Deepa Ramadurai1,2,3, Heta Patel4, Summer Peace5
1Division of Pulmonary, Allergy, and Critical Care Medicine, Philadelphia, PA.
CHEST critical care
|September 6, 2024
概括
医疗ICU临床医生很少将健康的社会决定因素 (SDOH) 纳入患者护理讨论中. 整合SDOH需要多学科的团队来改善重症监护. 关键词:健康的社会决定因素,危急疾病,医疗ICU.
科学领域:
- 关键护理医学 关键护理医学
- 公共卫生 公共卫生
- 社会学 社会学 社会学
背景情况:
- 健康的社会决定因素 (SDOHs) 显著影响患者在危急疾病中的结果.
- 专业组织建议在医疗机构进行社会风险查.
- 目前用于在急性护理中识别和整合SDOH的临床实践尚不清楚.
研究的目的:
- 调查医疗重症监护室 (ICU) 临床医生如何在患者护理中运行SDOH.
- 了解目前将SDOH纳入重症患者临床决策中的情况.
主要方法:
- 在三个城市ICU的临床工作轮的民族观测.
- 预期招募有呼吸衰竭的成年患者.
- 使用基于理论的方法和CDC健康人SDOHs框架对现场笔记,叙事摘录和电子医疗记录进行定性编码和三角化.
主要成果:
- 临床医生很少在轮次 (>200小时的观察) 期间讨论患者的社会结构.
- 社会结构主要讨论了急性呼吸衰竭的原因,维持生命的治疗决策和护理过渡.
- 缺乏对食品和住房不安全等常见SDOH的系统数据收集;一些SDOH很少或从未讨论过.
结论:
- 临床医生目前并没有广泛地将许多已知的SDOH纳入ICU轮.
- 改善SDOH的整合需要利用多学科团队在各种危急疾病阶段确定合适的数据收集者.
- 未来的研究应该专注于临床医生,患者和护理人员对基于ICU的SDOH评估的可行性和可接受性的评估.
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