Kushida Clete A, Nichols Deborah A, Holmes Tyson H, Miller Ric, Griffin Kara, Cardell Chia-Yu, Hyde Pamela R, Cohen Elyse, Manber Rachel, Walsh James K
Stanford Sleep Medicine Center, Redwood City, CA.
Sausalito, CA.
Sleep. 2015 Feb 1;38(2):315-26. doi: 10.5665/sleep.4422.
The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control.
http://www.clinicaltrials.gov, NCT02037438.
目前,医学实践正在经历一场变革,以在提供医疗服务时变得更高效、更具成本效益且以患者为中心。本文旨在激发睡眠医学领域的讨论,探讨如何通过我们的方法以及其他睡眠医学护理方法来满足这些需求。“提供最佳护理研究的可持续方法、算法和研究工具”(SMART DOCS)的主要目标是:(1)为未来的睡眠医学实践引入一种新的以患者为中心的结局和协调护理管理(PCCM)方法;(2)在一项随机、双臂、单中心、长期、比较有效性试验中,将PCCM方法与传统诊断和治疗门诊医疗护理(CONV)方法进行对比测试。PCCM方法被整合到一种针对睡眠障碍患者的新型门诊护理提供模式中,该模式采用了最新技术,使医疗服务提供者能够获得更准确、快速的诊断,并做出基于证据的治疗建议,同时让患者能够获取有关其诊断和治疗的个性化医疗信息和报告,以便他们能够做出更明智的医疗保健决策。此外,PCCM方法有助于患者、转诊的初级保健医生、睡眠专家和相关健康专业人员之间更好地沟通,从而使医疗服务提供者能够更好地协助患者实现他们期望的结果。总共1506名18岁及以上的患者将被随机分配至PCCM或CONV方法组,并将被随访至少1年,终点指标为改善医疗保健绩效、增进健康和控制成本。