Division of Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Division of Nephrology, University of California, San Francisco, San Francisco, CA.
Semin Nephrol. 2024 May-Jul;44(3-4):151548. doi: 10.1016/j.semnephrol.2024.151548. Epub 2024 Aug 23.
Person-centered care is a system of care delivery that supports effective patient-clinician communication and empowers patients to partner with their clinical providers to develop goal-concordant treatment plans. Models of person-centered care often involve the implementation of patient-reported outcomes (PROs) to measure patients' symptoms and quality of life as they navigate complex chronic health conditions. Models of person-centered care have been particularly effective in improving the quality of care delivery for older adults as well as younger adults with aging-associated conditions such as physical function decline. Though PROs have been developed and validated in kidney disease, they are not routinely implemented in clinical practice. Most individuals with kidney disease are 65 and older, but many younger individuals with kidney disease also experience aging-associated conditions earlier than in the general population. Thus, PROs represent an important tool for achieving person-centered care in groups with kidney disease who are the most vulnerable to adverse health outcomes and excess health care utilization. In this article, we aim to move toward more routine implementation of PROs in kidney care for aging adults. To identify the most clinically relevant PROs for this group and understand the ideal mode and context in which to implement PROs, we will (1) provide an evidence-based summary of PROs with the greatest prognostic significance in the general population and in kidney disease, including those specific to older adults; (2) describe barriers to the implementation of PROs in kidney care with a special focus on the needs of older adults and younger adults with aging-associated conditions; and (3) conclude with our evidence-based recommendations for the content, time, and context in which PROs should be implemented to achieve person-centered kidney care for aging adults.
以人为本的护理是一种护理提供系统，支持有效的医患沟通，并使患者能够与临床提供者合作，制定与目标一致的治疗计划。以人为本的护理模式通常涉及实施患者报告的结果 (PROs)，以衡量患者在应对复杂慢性健康状况时的症状和生活质量。以人为本的护理模式在改善老年人以及与年龄相关的疾病（如身体功能下降）的年轻成年人的护理质量方面特别有效。虽然已经开发和验证了用于肾脏疾病的 PROs，但它们并未在临床实践中常规实施。大多数患有肾脏疾病的人年龄在 65 岁及以上，但许多患有肾脏疾病的年轻人也比一般人群更早地经历与年龄相关的疾病。因此，PROs 是实现肾脏疾病患者以人为本护理的重要工具，这些患者最容易出现不良健康结果和过度医疗利用。在本文中，我们旨在推动在老年肾脏护理中更常规地实施 PROs。为了确定最适合该人群的最具临床相关性的 PROs，并了解在实施 PROs 方面的理想模式和环境，我们将：(1) 提供具有最大预后意义的 PROs 的循证总结，包括一般人群和肾脏疾病中的 PROs，包括专门针对老年人的 PROs；(2) 描述在肾脏护理中实施 PROs 的障碍，特别关注老年人和与年龄相关的疾病的年轻成年人的需求；(3) 最后根据我们的循证建议，确定 PROs 的内容、时间和环境，以实现老年成年人的以人为本的肾脏护理。
