癌症患者的基于算法的息护理:一个集群随机临床试验
Ravi B Parikh1,2, William J Ferrell3,4, Yang Li3
1Division of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia.
JAMA network open
|February 21, 2025
概括
基于算法的电子健康记录 (EHR) 默认值显著增加了晚期癌症患者的息治疗 (PC) 咨询. 这一策略还减少了生命终端系统治疗,为社区瘤学提供了可扩展的解决方案.
科学领域:
- 在瘤学瘤学.
- 抚慰性护理是一种缓解性护理.
- 医疗信息学 医疗信息学
背景情况:
- 准则推的早期专业息护理 (PC) 获取在社区瘤诊所为高级固体瘤患者的设置是有限的.
- 需要有效的策略来将PC纳入常规癌症护理.
研究的目的:
- 评估电子健康记录 (EHR) 中基于算法的默认值,包括选择退出选项和负责任的理由,是否可以增加完成的PC访问.
- 评估这项干预措施对以患者为中心的结果和终身护理的影响.
主要方法:
- 一个双臂集群随机临床试验,涉及田纳西州15家社区瘤诊所.
- 通过EHR算法识别了晚期肺癌或胃肠癌患者.
- 干预站点使用了PC订单的EHR默认值,并为选择退出提供了负责任的理由;控制站点根据临床医生的判断管理了转诊.
主要成果:
- 与对照组 (8.3%) 相比,干预组的完成PC访问率 (43.9%) 显著更高 (调整后的赔率比,8.9).
- 干预组的患者在死亡14天内接受的系统疗法较少 (6.5%与16.1%相比).
- 没有观察到生活质量或感觉被听到和理解的显著差异.
结论:
- 基于算法的EHR默认值与可追究的理由代表了一个可扩展的策略,以提高PC转诊在社区瘤学.
- 这种方法有效地增加了PC咨询,并可能减少强化生命终端治疗.
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