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在代谢和腹部外科手术中加强共享决策:多系统实施和评估
David E Arterburn1, Robert Wellman1, Anita Courcoulas2
1Kaiser Permanente Washington Health Research Institute Seattle Washington USA.
Obesity science & practice
|December 8, 2025
概括
在代谢和减肥手术 (MBS) 中实施共享决策 (SDM) 工具显示出混合的结果. 虽然转诊和手术在一个地点增加,但感知到的SDM质量下降,这表明需要更广泛的体重管理选项.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 以患者为中心的护理
背景情况:
- 共享决策 (SDM) 对于优化患者在代谢和减肥手术 (MBS) 中的选择至关重要.
- 系统地实施SDM工具旨在改善患者参与和MBS的结果.
研究的目的:
- 通过在两个大型医疗保健系统中实施和评估SDM工具,增强代谢和减肥手术 (MBS) 中的SDM.
- 评估SDM工具整合对患者报告结果和临床工作流程的影响.
主要方法:
- 开发并将SDM工具集成到两个卫生系统的临床工作流程中.
- 接受过培训的临床医生在接受MBS的合格患者使用决策辅助工具.
- 通过患者调查,电子健康记录 (EHR) 和临床医生访谈收集数据,重点关注合作RATE SDM措施.
主要成果:
- 1675名患者使用决策辅助工具,导致MBS转诊和手术在一个地点 (KPWA) 增加,而不是在另一个地点 (UPMC).
- 基线SDM质量很高,但实施后的CollaboRATE得分显著下降,表明SDM质量有所下降.
- 质量反揭示了实施挑战和将SDM工具集成到实践中的成功.
结论:
- SDM工具的实施产生了混合的结果,MBS转诊率和外科手术率因地点而异.
- 实施后观察到SDM质量的感知下降,尽管基线水平很高.
- 未来的策略应该包括全面的体重管理选择,包括药物和生活方式干预,以及外科考虑.
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