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为了追求以价值为基础的护理,停止实施脊柱注射:重新思考缓解疼痛的方法
Lindsay A Ballengee1, Trevor A Lentz2, Christine Goertz3
1Duke University School of Medicine, Department of Population Health Sciences, 215 Morris Street, Durham, NC 27701, USA; Duke University School of Medicine, Department of Orthopaedic Surgery, 311 Trent Drive, Durham, NC 27710, USA; Duke Clinical Research Institute, 300 W. Morgan Street, Durham, NC 27701, USA.
脊柱注射用于慢性腰痛往往是低价值的护理. 需要取消实施策略,将资源转移到基于证据的疼痛管理,改善结果和患者的信任.
科学领域:
- 实施科学 实施科学
- 医疗服务研究 医疗服务研究
- 疼痛管理 疼痛管理
背景情况:
- 腰部疼痛患者经常接受低价值的护理,例如脊髓注射,尽管有指导方针.
- 低价值干预的持续性是由财政激励,提供者规范和患者期望驱动的.
- 这种脱节凸显了改革疼痛管理实践的重大挑战.
研究的目的:
- 将实施科学概念应用于慢性腰部疼痛中脊髓注射的实施.
- 检查支持使用脊髓注射的多层次决定因素.
- 提出战略和退出实施的路线图.
主要方法:
- 对脊柱注射的有效性和风险的证据的审查.
- 对持续使用的多层次决定因素 (提供者,患者,组织,系统) 的分析.
- 实施科学框架的应用,以消除实施.
主要成果:
- 脊柱注射治疗慢性腰部疼痛的有效性有限,并带有风险.
- 多层次因素有助于这些低价值程序的根深蒂固的使用.
- 提出了四个步骤的路线图和各种策略,用于执行.
结论:
- 停止进行脊柱注射是优化疼痛治疗的必要步骤.
- 将退出实施重新定义为重新设计护理,而不是取消治疗,有助于改变.
- 将资源从无效注射转向以证据为基础的替代方案可以改善结果,公平和信任.
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