在四个基于价值的医疗保健计划中对患者报告结果的实施和使用的现实评估
Mayara S Bianchim1, Ellie Crane1, Leah McLaughlin1
1School of Health Sciences, Bangor University, Bangor, UK.
Journal of advanced nursing
|July 29, 2025
概括
患者报告结果指标 (PROMs) 显示了基于价值的医疗保健 (VBHC) 计划的可变成功. 虽然PROM对心力衰竭有益,但需要系统支持和患者参与才能有效改善结果.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 基于价值的医疗保健
- 患者报告的结果衡量结果.
背景情况:
- 关于患者报告结果测量 (PROMs) 在各种常规医疗保健环境中的有效性的证据有限.
- 了解影响价值基础医疗 (VBHC) PROM实施的上下文因素对于优化患者护理至关重要.
研究的目的:
- 在四个不同的基于价值的医疗保健 (VBHC) 计划中调查患者报告结果措施 (PROM) 的机制,背景和受益人.
- 确定促使PROM在常规临床实践中成功或不成功实施的因素.
主要方法:
- 使用现实的评估方法来探索"什么有效,为谁有效,在什么情况下有效,为什么有效".
- 数据通过范围审查,文档分析,问卷,例行收集的定量数据和与心力衰竭,帕金森病,和白内障手术计划中的患者,护理人员和工作人员进行半结构面试来收集.
- 在整个评估期间 (2022年7月至2023年8月) 开发,测试和完善了程序理论和逻辑模型.
主要成果:
- 在心力衰竭和计划中,PROMs促进了改善分组,治疗量身定制和护理优先级,导致更有效地利用资源和更好地管理心力衰竭的症状.
- 实施挑战,包括缺乏IT集成,工作量增加,员工抵抗和数据利用不一致,阻碍了PROM在白内障手术和帕金森病计划中的有效性.
- 对于患者来说,获得专业精神卫生服务仍然是一个障碍,尽管PROM确定了需求.
结论:
- 在VBHC环境中,PROMs的普遍益处受到挑战;它们的有效性高度依赖于系统支持,集成和适应.
- PROM通常不适合长期的常规护理,没有显著的适应,需要更多的员工和患者参与,以提高接受度和相关性.
- 成功实施需要现实的战略,强大的数字基础设施,明确的领导力和共同设计的面向患者的工具,以提高参与度和可访问性.
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