Involving patients in setting priorities for healthcare improvement: a cluster randomized trial.
Involving patients in setting priorities for healthcare improvement: a cluster randomized trial.
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DOI：
10.1186/1748-5908-9-24
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发表时间：
2014-02-20
期刊：
影响因子：
--
通讯作者：
Grol R
中科院分区：
文献类型：
--
作者：
Boivin A;Lehoux P;Lacombe R;Burgers J;Grol R
患者越来越被视为医疗保健的积极合作伙伴。虽然人们对患者参与个人临床决策进行了广泛研究，但没有试验评估患者如何有效参与影响人群的集体医疗保健决策。本研究的目的是测试在社区一级，让患者参与制定慢性病护理的医疗保健改善优先事项的影响。设计：整群随机对照试验。当地社区在干预（患者参与的优先级设置）和对照部位（无患者参与）中进行随机分配。设定：加拿大一个地区的社区被要求从37个经过验证的质量指标中确定改善初级保健中慢性病管理的优先事项。干预：在与专业人员进行面对面的讨论之前，以书面形式咨询患者。控制：专业人员之间建立优先级，没有病人的参与。参会人员：共有来自六个社区的172人参与了这项研究，其中包括83名慢性病患者和89名卫生专业人员。结果：主要结果是患者和专业人员的优先级之间的协议水平。次要结果包括专业人员使用所选质量指标的意图，以及患者参与的成本。与患者建立的优先事项与医疗之家和慢性病护理模式的核心通用组件更加一致，包括：获得初级保健，自我护理支持，患者参与临床决策以及与社区组织的合作伙伴关系（p < 0.01）。由专业人员单独确定的优先事项更加强调单一疾病管理的技术质量。介入干预促进了患者和专业人员之间的相互影响，导致对共同优先事项的一致性增加了41%（95%CI：+12%to +58%，p < 0.01）。专业人员使用选定的质量指标的意图是类似的干预和控制网站。患者的参与使优先级排序过程的成本增加了17%，并且需要多10%的时间才能就共同的优先级达成共识。患者参与可以改变优先事项，推动人口水平的医疗保健改善。未来的研究应测试这些发现的推广到其他情况下，并评估其对病人护理的影响。荷兰国家试验注册编号NTR2496。
Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level. Design: Cluster randomized controlled trial. Local communities were randomized in intervention (priority setting with patient involvement) and control sites (no patient involvement). Setting: Communities in a canadian region were required to set priorities for improving chronic disease management in primary care, from a list of 37 validated quality indicators. Intervention: Patients were consulted in writing, before participating in face-to-face deliberation with professionals. Control: Professionals established priorities among themselves, without patient involvement. Participants: A total of 172 individuals from six communities participated in the study, including 83 chronic disease patients, and 89 health professionals. Outcomes: The primary outcome was the level of agreement between patients’ and professionals’ priorities. Secondary outcomes included professionals’ intention to use the selected quality indicators, and the costs of patient involvement. Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model, including: access to primary care, self-care support, patient participation in clinical decisions, and partnership with community organizations (p < 0.01). Priorities established by professionals alone placed more emphasis on the technical quality of single disease management. The involvement intervention fostered mutual influence between patients and professionals, which resulted in a 41% increase in agreement on common priorities (95%CI: +12% to +58%, p < 0.01). Professionals’ intention to use the selected quality indicators was similar in intervention and control sites. Patient involvement increased the costs of the prioritization process by 17%, and required 10% more time to reach consensus on common priorities. Patient involvement can change priorities driving healthcare improvement at the population level. Future research should test the generalizability of these findings to other contexts, and assess its impact on patient care. The Netherlands National Trial Register #NTR2496.
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影响因子：
--
作者：
Boivin, Antoine;Currie, Kay;Burgers, Jako
通讯作者：
Burgers, Jako
影响因子：
7.2
作者：
Boivin, Antoine;Lehoux, Pascale;Grol, Richard
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影响因子：
5.4
作者：
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影响因子：
2.2
作者：
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通讯作者：
Blozik E
影响因子：
14.6
作者：
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通讯作者：
Fradette, M