共享决策和患者决策辅助器,用于皮肤穿透的左心室尾闭塞
Joshua B Rager1,2, Chien-Yu Huang3, Sarah Zimmerman3
1Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis.
JAMA network open
|February 13, 2026
概括
在皮肤穿透左心房尾闭塞 (pLAAO) 之前,共享决策 (SDM) 和患者决策辅助 (DA) 的使用增加,但因机构而异. 尽管有CMS要求,Medicare患者没有显示SDM加DA使用的几率更高.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 患者参与 患者参与
背景情况:
- 在心房患者皮肤穿左心房尾闭塞 (pLAAO) 之前,建议共享决策 (SDM).
- 医疗保险和医疗补助服务中心 (CMS) 授权SDM提供患者决策辅助工具 (DAs) 进行pLAAO补偿.
- 目前关于SDM和DA使用pLAAO的实践模式在很大程度上仍然没有特征.
研究的目的:
- 评估pLAAO程序中报告的SDM和DA使用趋势.
- 确定影响SDM和DA利用的患者,操作员和机构因素.
主要方法:
- 一项队列研究分析了来自NCDR LAAO注册表的2022年10月至2024年6月的数据.
- 包括接受第一次PLAAO手术的患者.
- 层次逻辑回归检查了与SDM加DA报告相关的因素.
主要成果:
- 分析了超过1.47万名患者的接触情况;64.7%的人最初报告使用SDM加DA,到2024年6月达到75.0%.
- 观察到SDM加DA报告的机构差异很大 (平均概率为52.0%,范围为0.1%-76.4%).
- 对于医疗保险患者和非医疗保险患者来说,SDM加DA几率没有显著差异.
结论:
- 虽然PLAAO的SDM加DA报告量很大,但机构差异很大.
- CMS的要求似乎并没有使SDM和DA在不同患者群体的使用相等.
- 对SDM和DA实施的制度障碍和促进者的进一步研究是有必要的.
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