Cohen-Stavi Chandra J, Key Calanit, Molcho Tchiya, Yacobi Mili, Balicer Ran D, Shadmi Efrat
Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.
Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Med Care Res Rev. 2022 Feb;79(1):102-113. doi: 10.1177/1077558720975543. Epub 2020 Dec 2.
Reasons why care does not conform to single-disease guideline recommendations for multimorbid patients have not been systematically measured in practice. Using a mixed methods approach, we identified and quantified types of reasons why care deviates from nine sets of disease guideline recommendations for multimorbid patients. Utilizing a focus group concept mapping technique, we built on a categorization of reasons explaining guideline deviation, and surveyed treating nurses about these reasons for patients' specific care processes. Directed content analysis was conducted to classify the responses into reasons categories. Of 4,386 guideline-recommended care processes evaluated, 920 were not guideline-concordant (944 reasons). Three broad categories of reasons and 18 specific reasons were identified: Biomedical-related occurred 35.2% of the time, patient personal-related (30.4%), context-related (18.4%), and unknown (16.0%). Patient- and context-related factors are prevalent drivers for guideline deviation in multimorbidity, demonstrating that patient-centered aspects are as much a part of care decisions as biomedical aspects.
在实践中，尚未系统地衡量护理不符合多病患者单一疾病指南建议的原因。我们采用混合方法，识别并量化了护理偏离针对多病患者的九套疾病指南建议的原因类型。利用焦点小组概念映射技术，我们基于对指南偏差原因的分类，并就患者特定护理过程的这些原因对治疗护士进行了调查。进行定向内容分析以将回复分类到原因类别中。在评估的4386个指南推荐护理过程中，920个不符合指南（944个原因）。确定了三大类原因和18个具体原因：生物医学相关原因占35.2%，患者个人相关原因（30.4%），背景相关原因（18.4%），以及未知原因（16.0%）。患者和背景相关因素是多病情况下指南偏差的普遍驱动因素，表明以患者为中心的方面与生物医学方面一样，都是护理决策的一部分。
