使用实施科学来评估在临床心力衰竭护理环境中患者报告的结果措施 (PROM) 的实施情况
Sarah V C Lawrason1,2, Heather Ross1,2, Michael McDonald1,2
1University Health Network, Toronto, Ontario, Canada.
CJC open
|December 30, 2024
概括
患者报告的结果措施 (PROMs) 改善了心力衰竭护理质量. 实施科学框架确定了更好地将PROM整合到临床实践中的障碍和解决方案.
科学领域:
- 实施科学 实施科学
- 医疗保健服务研究 医疗服务研究
- 数字健康数字健康
背景情况:
- 心力衰竭 (HF) 显著影响患者的生活质量 (QOL),导致住院治疗和疾病进展.
- 患者报告的结果措施 (PROMs) 捕捉患者关于症状,功能和QOL的经验,将他们的声音纳入临床护理.
- 2022年,PROM在一家主要的学术医院的Epic电子健康记录系统中实施.
研究的目的:
- 通过实施科学框架,系统地评估PROMs在临床HF护理中的采用和整合.
- 确定PROM采用和在现实临床环境中有效使用的障碍和促进者.
- 为优化PROM在医疗保健系统中的实施提供可行的建议.
主要方法:
- 一个为期一年的质量改进项目,以 RE-AIM 框架为指导,以覆盖范围,有效性,采用,实施和维护为指导.
- 混合方法方法利用临床医生使用数据,患者级PROM完成数据和与临床医生进行半结构面试.
- 使用描述性统计数据分析定量数据,使用行为变化框架和潜在内容分析分析定性数据.
主要成果:
- 在研究年度中,PROM的患者分配和完成率增加.
- 大约80%的患者在堪萨斯城心肌病问卷-12 (KCCQ-12) 中获得了高分.
- 临床医生发现了与关注,决策过程,环境背景和影响PROM整合的专业角色相关的障碍.
结论:
- 实施科学框架对于评估PROM实施和产生实际建议是有价值的.
- 建议的改进包括多语言PROM支持,减少临床医生在EHR中的认知负载,以及使用PROM的领导模式.
- 系统性评估促进了可操作的见解,以加强PROMs在常规临床实践中的整合,以改善患者的治疗结果.
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