评估在学术住院患者环境中公平遵守年龄友好型卫生系统的4M框架
Julia Adler-Milstein1, Robert Thombley1, Sarah Rosenthal1
1University of California, San Francisco, CA, USA.
Inquiry : a journal of medical care organization, provision and financing
|September 24, 2024
概括
实现对年龄友好型卫生系统的一致遵守.
科学领域:
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 成千上万的医疗系统使用年龄友好型医疗系统的4Ms框架来改善对老年人的护理.
- 始终坚持4M护理流程对于有效实施至关重要.
- 了解影响坚持的机制是实现公平护理的关键.
研究的目的:
- 确定和评估影响遵守4M框架的机制.
- 检查隐性偏见与4M坚持之间的关联.
- 评估综合老年医疗护理对守护的影响.
主要方法:
- 在UCSF健康系统3年内对28833名住院患者 (65岁以上的患者) 进行了回顾性观察性研究.
- 最小平方回归模型用于评估4Ms坚持和患者/遭遇特征之间的关联.
- 假设的机制包括隐含的偏见和全面的老年保健联系.
主要成果:
- 总体而言,在遭遇层面上,对4M框架的遵守率为65.5%.
- 消极隐性偏见与肥胖患者和医疗补助计划的患者的遵守率较低有关.
- 阳性隐性偏差与最年长的老年人 (85岁以上) 和行动能力低下的患者更高的坚持相关.
- 综合老年人护理接触 (ACE单位,老年人咨询) 与显著更高的坚持 (5.33 PP) 相关.
结论:
- 隐含的偏见,无论是积极的还是消极的,似乎影响了4M的坚持.
- 与综合老年医疗保健的接触显示出强烈的积极关联与坚持.
- 这些发现可以为公平提供年龄友好型护理的战略提供信息.
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