使用实施科学来鼓励严重疾病的对话关于通用医学住院服务:一个中断的时间序列
Myrna Katalina Serna1, Catherine Yoon2, Julie Fiskio2
1Division of General Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
Journal of hospital medicine
|October 29, 2024
概括
实施干预措施并没有显著增加住院患者的严重疾病对话 (SIC),尽管解决了患者识别障碍. 需要进一步的研究,以改善SIC融入临床工作流程.
科学领域:
- 实施科学 实施科学
- 改善医疗保健质量 改善医疗保健质量
- 抚慰性护理是一种缓解性护理.
背景情况:
- 严重疾病对话 (SIC) 对于以患者为中心的护理至关重要,但与医院的工作流程不一致.
- 对SICs的障碍包括工作流的挑战和COVID-19大流行等外部因素.
研究的目的:
- 评估旨在增加住院患者严重疾病对话 (SIC) 的干预措施的实施情况.
- 确定影响SIC整合到住院环境中的决定因素和障碍.
主要方法:
- 利用实施研究的综合框架和实施变革的专家建议.
- 对具有高再入院风险 (RRS>28%) 的成人通用医学住院患者 (2019年1月至2021年10月) 进行了中断时间序列分析.
- 干预措施包括通过质量和安全仪表板 (QSD) 识别患者,推广和培训.
主要成果:
- 尽管进行了干预,但标准化SIC文档的几率没有显著变化 (OR1.16,95%CI0.98-1.39).
- 障碍包括COVID-19相关的挑战 (例如人口普查),而促进者包括现有计划和息护理咨询.
- 使用QSD和再入院风险评分 (RRS) 缓解了患者识别障碍.
结论:
- 不足或无效的干预措施,加上COVID-19的挑战,可能导致SIC文档没有显著改善.
- 虽然解决了患者识别问题,但整体SIC实施需要进一步改进.
- 需要进行额外的研究,以优化SIC在住院护理中的整合.
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