A Systematic Intervention To Improve Serious Illness Communication In Primary Care
A Systematic Intervention To Improve Serious Illness Communication In Primary Care
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DOI：
10.1377/hlthaff.2017.0219
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发表时间：
2017-07-01
期刊：
影响因子：
9.7
通讯作者：
Bernacki, Rachelle E.
中科院分区：
文献类型：
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作者：
Lakin, Joshua R.;Koritsanszky, Luca A.;Bernacki, Rachelle E.
对于患有晚期重病、生命即将走到尽头的患者，加强有关目标和价值观的沟通是提高医疗价值的关键契机。在马萨诸塞州波士顿市布莱根妇女医院附属的初级医疗诊所实施的重病护理项目是一种多成分干预措施，旨在支持临床医生进行最佳沟通实践，以增加与重病患者就其目标和价值观展开的对话。我们对参与一个基于责任医疗组织的高风险医疗管理项目的14家初级医疗诊所的该项目进行了研究。实施了该项目的诊所中的患者比对照诊所中的患者更有可能在病历中记录有重病相关对话，包括对价值观和目标的讨论。参与项目的临床医生还报告称，他们对作为项目一部分所接受的培训满意度很高，并认为培训是有效的。这项工作表明，重病护理项目促进了部分初级医疗患者之间更多、更好的对话，并凸显了进一步研究的必要性。
Improving communication about goals and values for patients with advancing serious illness nearing the end of life is a key opportunity to improve the value of care. The Serious Illness Care Program, implemented at primary care clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts, is a multicomponent intervention designed to support best practices in communication by clinicians to increase conversations with patients with serious illness about their goals and values. We conducted a study of the program in fourteen primary care clinics participating in a high-risk care management program based in an accountable care organization. Patients in the clinics with the program implemented were more likely than those in comparison clinics to have serious illness conversations-including discussion of values and goals-documented in patients' medical records. Clinicians who participated also reported high satisfaction with training they received as part of the program, which they regarded as effective. This work suggests that the Serious Illness Care Program promotes more and better conversations among selected primary care patients, and it highlights the need for further research.