在学术医疗中心和县级医疗保健系统中，前列腺癌男性患者共同决策计划实施结果的差异。
Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System.
机构信息
Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
University of California San Francisco, School of Medicine, San Francisco, CA, USA.
出版信息
Med Decis Making. 2021 Feb;41(2):120-132. doi: 10.1177/0272989X20982533. Epub 2021 Jan 13.
BACKGROUND
Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings.
METHODS
We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey.
RESULTS
Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, = 0.01) and the health care system (77% v. 35%, = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, = 0.04). Implementation strategies (e.g., faxing of patients' records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county.
CONCLUSIONS
Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.
背景
共享决策制定（SDM）长期以来一直被倡导为医生和前列腺癌患者做出治疗决策的首选方式。然而，在常规护理中实施正式的 SDM 计划仍然有限，而且弱势群体的实施结果描述得尤其差。我们描述了学术和县级医疗保健环境之间的实施结果。
方法
我们在学术中心和县级医疗保健系统中为局部前列腺癌男性患者实施了决策辅助工具（DA）。我们的实施受到实施研究综合框架和实施、有效性、采用、实施和维护框架的指导。我们通过预约后患者调查评估 DA 的有效性。
结果
各站点之间的患者人口统计学/临床特征存在差异。在学术中心和县级（66%比 60%，=0.37），DA 邀请率（DA 邀请率）相似且不受实施策略的影响。在学术中心和县级，DA 完成率（DA 完成率）也相似（77%比 80%，=0.74）。除了学术中心的医生和医疗保健系统的净推荐值更高（77%比 37%，=0.01 和 77%比 35%，=0.006）以及对护理方式的满意度更高（中位数为 100 比 87.5，=0.04）之外，DA 有效性在两个站点之间相似。实施策略（例如，传真患者记录和在诊所与患者会面以完成 DA）在两个站点都代表了实质性的实践变化。在学术中心开始提醒电话和在县级创建西班牙语模块后，完成率增加。
结论
成功的 DA 实施工作应侧重于患者参与和获得。SDM 可能广泛使患者和医疗保健系统受益，而与患者人口统计学/临床特征无关。
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