Value-based syncope evaluation and management: Perspectives of health care professionals on readiness, barriers and enablers.
Value-based syncope evaluation and management: Perspectives of health care professionals on readiness, barriers and enablers.
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DOI：
10.1016/j.ajem.2020.05.029
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Williams MV
中科院分区：
文献类型：
--
作者：
Li J;Gupta V;Smyth SS;Cowley A;Du G;Sirrine M;Stearley S;Chadha R;Bhalla V;Williams MV
晕厥是急诊科常见的情况。鉴于晕厥的病因很多，对晕厥的评估和管理已有研究。然而，医生对晕厥患者的治疗方法是多种多样的，而且往往不是基于价值。2017年ACC/AHA/HRS晕厥患者评估和管理指南包括对不必要的医疗检查的关注。然而，很少有研究评估指导方针的实施情况。采用混合方法。目标提供者的专业包括急诊医学、医院医学和心脏病学。循证实践态度量表-36和组织变革准备评估调查问卷被分发到四个不同的医院地点。然后，我们进行了焦点小组和关键信息者访谈，以获得更多关于临床医生对以指南为基础的实践的看法以及实施的障碍/促进者的信息。调查分析采用描述性统计和双变量分析。NVivo使用两阶段编码来识别主题。对调查的分析显示，对循证做法的总体态度是温和的，新指南的实施被视为一种负担，可能会降低遵从性。不同医院的情况有所不同。从采访中发现了五个共同的主题：晕厥诊断的不确定性，医疗保健中消费主义的兴起，与患者沟通的挑战，标准化护理中的提供者差异，以及组织变革的过程。尽管建议使用晕厥指南，但依从性并不理想。克服使用障碍将需要一种范式的转变。需要多方面的方法和协作关系来遵守指导方针，以提高患者护理和操作效率。
Syncope is a common condition seen in the emergency department. Given the multitude of etiologies, research exists on the evaluation and management of syncope. Yet, physicians’ approach to patients with syncope is variable and often not value based. The 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients with Syncope includes a focus on unnecessary medical testing. However, little research assesses implementation of the guidelines. Mixed methods approach was applied. The targeted provider specialties include emergency medicine, hospital medicine and cardiology. The Evidence-based Practice Attitude Scale-36 and the Organizational Readiness to Change Assessment surveys were distributed to four different hospital sites. We then conducted focus groups and key informant interviews to obtain more information about clinicians’ perceptions to guideline-based practice and barriers/facilitators to implementation. Descriptive statistics and bivariate analyses were used for survey analysis. Two-stage coding was used to identify themes with NVivo. Analysis of surveys revealed that overall attitude toward evidence-based practices was moderate and implementation of new guidelines were seen as a burden, potentially decreasing compliance. There were differences across hospital settings. Five common themes emerged from interviews: uncertainty of a syncope diagnosis, rise of consumerism in health care, communication challenge with patient, provider differences in standardized care, and organizational processes to change. Despite recommendations for the use of syncope guidelines, adherence is suboptimal. Overcoming barriers to use will require a paradigm shift. A multifaceted approach and collaborative relationships are needed to adhere to the Guidelines to improve patient care and operational efficiency.
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影响因子：
6.1
作者：
Rose, Marianne Sarah;Koshman, Mary-Lou;Sheldon, Robert
通讯作者：
Sheldon, Robert
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
与ED访问有关的晕厥访问相关的资源利用率的国家趋势。
DOI：
10.1016/j.ajem.2015.04.030
发表时间：
2015-08
期刊：
The American journal of emergency medicine
影响因子：
--
作者：
Probst MA;Kanzaria HK;Gbedemah M;Richardson LD;Sun BC
通讯作者：
Sun BC
DOI：
10.1016/j.jaac.2013.02.005
发表时间：
2013-05-01
影响因子：
13.3
作者：
Glisson, Charles;Hemmelgarn, Anthony;Williams, Nathaniel J.
通讯作者：
Williams, Nathaniel J.
影响因子：
7
作者：
Abadie, Bryan Q.;Hansen, Benjamin;Gehi, Anil K.
通讯作者：
Gehi, Anil K.