Wald Heidi L, Leykum Luci K, Mattison Melissa L P, Vasilevskis Eduard E, Meltzer David O
University of Colorado School of Medicine, Division of Health Care Policy and Research, Campus Box F480 13199 E. Montview Blvd, Suite 400, Aurora, CO, 80024, USA,
J Gen Intern Med. 2014 Jun;29(6):926-31. doi: 10.1007/s11606-014-2777-1.
As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.
随着美国人口老龄化，急症医院的患者群体年龄越来越大，医疗情况也越来越复杂。尽管有证据表明疾病负担重、成本高且护理结果往往不佳，但对于老年人急性疾病的表现、诊断策略和管理的了解却很有限。在本文中，我们提出了一项在医院医学和老年医学交叉领域制定研究议程的策略。这种方法是受患者为中心的结果研究机构（PCORI）用于确定研究领域并对其进行优先排序的框架所启发，强调患者和护理人员的意见。该框架的四个组成部分是：1）主题生成，2）系统评价中的差距分析，3）信息价值（VOI）分析，以及4）同行评审。强调了一个包容性的主题生成过程，该过程需要多个利益相关者，尤其是患者的系统参与。在后续步骤中，研究人员和利益相关者对研究主题进行优先排序，以确定在以患者为中心、人群影响、对临床决策的影响、实施的难易程度和持续性方面最优化的领域。最后，描述了研究议程传播的后续步骤以及对以患者为中心的研究优先排序过程影响的评估。
