睡眠障碍的发展和评估 适用于轻度创伤性脑损伤的退伍军人
Adam R Kinney1,2, Lisa A Brenner1,2, Morgan Nance1,2
1Author Affiliations: Department of Veteran Affairs, Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado (Drs Kinney, Brenner, Nance, Cobb, Forster, and Bahraini); Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Drs Kinney, Nance, and Forster); Departments of Physical Medicine and Rehabilitation Psychiatry, and Neurology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Brenner); Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans, Affairs, Durham, North Carolina (Dr Ulmer); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Dr Ulmer); Chief of Staff Office, James A. Haley Veterans Hospital, Department of Neurosurgery, University of South Florida, Tampa, Florida (Dr Nakase-Richardson); David Geffen School of Medicine at UCLA, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Fung); and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Bahraini).
对于患有轻度创伤性脑损伤 (mTBI) 和睡眠障碍的退伍军人来说,新型的决策辅助工具易于使用和实施. 建议改进设计以更好地融入常规护理和以退伍军人为中心的决策.
科学领域:
- 医疗信息学
- 临床决策支持
- 退伍军人的健康
背景情况:
- 同时发生的轻度创伤性脑损伤 (mTBI) 和睡眠障碍 (失眠,阻塞性睡眠呼吸暂停 (OSA)) 给退伍军人带来了独特的管理挑战.
- 分享决策 (SDM) 对于将治疗与退伍军人的偏好保持一致至关重要,特别是在复杂的案件中.
- 退伍军人卫生管理局 (VHA) 多创伤/TBI 护理系统 (PSC) 寻求创新工具来支持 SDM.
研究的目的:
- 为退伍军人设计和评估新的决策辅助原型.
- 在VHAPSC中评估这些决策辅助的可用性,可接受性和可行性.
- 收集反以完善原型并为未来的实施策略提供信息.
主要方法:
- 融合并行混合方法设计.
- 与临床医生 (n=7) 和退伍军人 (n=5) 的半结构面试.
- 验证的工具:系统可用性尺度和太华决策援助可接受性尺度.
主要成果:
- 决策援助原型被评为易于使用,易于获取和有效比较治疗方法.
- 参与者认为这些援助是可以接受的,提供了必要的信息,并促进了SDM.
- 建议包括设计简化,内容精细化和实施时间表的调整.
结论:
- 开发的决策辅助工具对于治疗经历了mTBI的退伍军人睡眠障碍是友好的,可接受的和可行的.
- 基于临床医生和退伍军人反的代设计改进对于最佳融入常规VHA护理至关重要.
- 这些发现支持实施决策辅助,以加强以退伍军人为中心的护理,并改善伴随疾病的结果.
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