New York City Health and Hospitals, 50 Water Street, New York, NY, 10013, USA.
New York University School of Medicine, New York, NY, USA.
J Gen Intern Med. 2022 Aug;37(10):2454-2461. doi: 10.1007/s11606-021-07269-4. Epub 2022 Jun 6.
The American Board of Internal Medicine Foundation's Choosing Wisely campaign has resulted in a vast number of recommendations to reduce low-value care. Implementation of these recommendations, in conjunction with patient input, remains challenging.
To create updated Society of Hospital Medicine Adult Hospitalist Choosing Wisely recommendations that incorporate patient input from inception.
This was a multi-phase study conducted by the Society of Hospital Medicine's High Value Care Committee from July 2017 to January 2020 involving clinicians and patient advocates.
Phase 1 involved gathering low-value care recommendations from patients and clinicians across the USA. Recommendations were reviewed by the committee in phase 2. Phase 3 involved a modified Delphi scoring in which 7 committee members and 7 patient advocates voted on recommendations based on strength of evidence, potential for patient harm, and relevance to either hospital medicine or patients. A patient-friendly script was developed to allow advocates to better understand the clinical recommendations.
A total of 1265 recommendations were submitted by clinicians and patients. After accounting for similar suggestions, 283 recommendations were categorized. Recommendations with more than 10 mentions were advanced to phase 3, leaving 22 recommendations for the committee and patient advocates to vote upon. Utilizing a 1-5 Likert scale, the top combined recommendations were reducing use of opioids (4.57), improving sleep (4.52), minimizing overuse of oxygen (4.52), reducing CK-MB use (4.50), appropriate venous thromboembolism prophylaxis (4.43), and decreasing daily chest x-rays (4.43).
Specific voting categories, along with the use of patient-friendly language, allowed for the successful co-creation of recommendations.
美国内科医师学会基金会的“明智选择”活动提出了大量减少低价值医疗的建议。这些建议的实施以及患者的参与仍然具有挑战性。
制定新的“医院医学学会成人医院医师明智选择”建议，从一开始就纳入患者的意见。
这是一项由医院医学学会高价值护理委员会进行的多阶段研究，涉及临床医生和患者权益倡导者，从 2017 年 7 月至 2020 年 1 月进行。
第 1 阶段涉及从美国各地的患者和临床医生那里收集低价值医疗建议。第 2 阶段由委员会审查建议。第 3 阶段涉及修改后的德尔菲评分，其中 7 名委员会成员和 7 名患者权益倡导者根据证据强度、对患者潜在危害以及对医院医学或患者的相关性，对建议进行投票。制定了一个患者友好的脚本，以允许权益倡导者更好地理解临床建议。
临床医生和患者共提交了 1265 条建议。在考虑到相似的建议后，将 283 条建议进行了分类。有 10 次以上提及的建议被推进到第 3 阶段，留下 22 条建议供委员会和患者权益倡导者投票。利用 1-5 级李克特量表，排名最高的综合建议是减少阿片类药物的使用（4.57）、改善睡眠（4.52）、尽量减少过度使用氧气（4.52）、减少 CK-MB 的使用（4.50）、适当的静脉血栓栓塞预防（4.43）和减少每日胸部 X 光检查（4.43）。
具体的投票类别，以及使用患者友好的语言，使得建议的成功共同制定成为可能。
