Moser Eileen M, Huang Grace C, Packer Clifford D, Glod Susan, Smith Cynthia D, Alguire Patrick C, Fazio Sara B
Department of Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania.
Shapiro Institute for Education and Research, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
J Hosp Med. 2016 Mar;11(3):217-20. doi: 10.1002/jhm.2489. Epub 2015 Sep 28.
Medical students must learn how to practice high-value, cost-conscious care. By modifying the traditional SOAP (Subjective-Objective-Assessment-Plan) presentation to include a discussion of value (SOAP-V), we developed a cognitive forcing function designed to promote discussion of high-value, cost-conscious care during patient delivery. The SOAP-V model prompts the student to consider (1) the evidence that supports a test or treatment, (2) the patient's preferences and values, and (3) the financial cost of a test or treatment compared to alternatives. Students report their findings to their teams during patient care rounds. This tool has been successfully used at 3 medical schools. Preliminary results find that students who have been trained in SOAP-V feel more empowered to address the economic healthcare crisis, are more comfortable in initiating discussions about value, and are more likely to consider potential costs to the healthcare system.
医学生必须学会如何践行高价值、注重成本的医疗服务。通过对传统的SOAP（主观-客观-评估-计划）报告形式进行修改，使其包含对价值的讨论（SOAP-V），我们开发了一种认知强制功能，旨在在患者诊疗过程中促进对高价值、注重成本的医疗服务的讨论。SOAP-V模型促使学生考虑：（1）支持某项检查或治疗的证据；（2）患者的偏好和价值观；（3）某项检查或治疗与其他选择相比的财务成本。学生在患者护理查房期间向团队汇报他们的发现。该工具已在三所医学院成功使用。初步结果表明，接受过SOAP-V培训的学生在应对经济医疗危机方面更有信心，在发起关于价值的讨论时更自在，并且更有可能考虑对医疗系统的潜在成本。
