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转变以患者为中心的护理:通过参与模式发展循证决策

Transforming Patient-Centered Care: Development of the Evidence Informed Decision Making through Engagement Model.

作者信息

Moore Jennifer E, Titler Marita G, Kane Low Lisa, Dalton Vanessa K, Sampselle Carolyn M

机构信息

Office of Women's Health & Gender Research, U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Office of Extramural Research, Education, and Priority Populations, Rockville, Maryland.

Department of Health Behavior and Biological Sciences, University of Michigan, School of Nursing, Ann Arbor, Michigan.

出版信息

Womens Health Issues. 2015 May-Jun;25(3):276-82. doi: 10.1016/j.whi.2015.02.002. Epub 2015 Apr 9.

Abstract

BACKGROUND

In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link.

DISCUSSION

Through a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model's ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve.

CONCLUSIONS

In the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process.

摘要

背景

为应对美国《平价医疗法案》的通过,临床医生和研究人员正在严格评估让患者参与实施循证护理以改善健康结果的方法。然而,大多数实施模式仅将临床医生或卫生系统作为循证的采用者。在这些模式中,患者在很大程度上被忽视了。一种能够体现患者在循证应用中复杂但重要作用的新实施模式可能是关键的缺失环节。

讨论

通过理论评估和发展过程,我们通过将择期引产研究中的定性数据进行映射,在一个实施模式中探索以患者为中心的概念(患者激活和共同决策),以评估该模式捕捉这些关键概念的能力。该过程表明需要一种新的、以患者为中心的实施模式。作为回应,我们提出了通过参与实现循证决策模式。我们得出结论,通过将女性完全纳入实施模式,对临床医生和患者都重要的结果将会改善。

结论

为了在孕期和分娩期间为女性提供循证护理,以患者为中心的护理至关重要。本文所讨论概念的纳入有可能超越孕产妇护理领域并影响其他临床领域。利用新开发的通过参与实现循证决策模式提供了一个利用证据并将其转化为实践的框架,同时承认女性在这一过程中的重要作用。

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