Standardized and individualized care: do they complement or oppose each other?
Standardized and individualized care: do they complement or oppose each other?
复制标题
标准化和个性化护理：它们是互补还是对立？
DOI：
10.1111/dmcn.13969
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发表时间：
2018
影响因子：
3.8
通讯作者：
V. Schiariti
中科院分区：
文献类型：
--
作者：
V. Schiariti
编辑-通用数据元素(CDE)项目的总体目标是标准化对脑瘫(CP)儿童和青年研究中的数据收集和评估。费尔赫斯特博士的评论提出了以下问题：标准化医疗能否与个性化医疗共存，而不会失去灵活的医学艺术？标准化促进循证医学(或最佳可用证据)的系统化应用，以确保患者得到有效的护理。我们需要在临床实践中减少差异，以实现更一致的结果，并提高护理质量和患者安全。另一方面，个性化护理依赖于卫生专业人员很好地了解他们的患者，并将他们视为独特的个体。个性化改善了患者的体验，增加了他们的参与度和健康知识。虽然临床护理的标准化--使用通用框架、CDE、测量工具箱、核心集合、护理路径--对于支持循证实践是有价值的，但来自儿童及其家人观点的经验仍然可以个性化。必须指出的是，在标准化护理中，仍然需要根据儿童和家庭的喜好和选择作出决定。为干预设定目标和优先顺序、疼痛管理技术以及引入辅助技术的类型和时间都是客户做出决策以满足其个性化需求的例子。因此，我们可以同时实现标准化和个性化护理。为患有CP的儿童和年轻人推荐的CDE使这一人群的数据收集标准化。在CP中，标准化和个性化是相辅相成的。最重要的是，标准化可以通过消除使用低质量评估工具的不必要时间和成本，或者忽略获得相关临床信息的机会来增强个性化，这反过来又将并发症或不符合最佳循证实践的不适当治疗降至最低。卫生专业人员经常根据他们独特的临床教育和经验做出评估和治疗决定。标准化弥补了病史和经验的这种差异，并协调了对结果的评估、评价和报告，最终促进了研究研究和治疗干预之间的信息比较。最后，我们认为，良好的同理心护理的本质是建立在卫生专业人员与儿童和家庭之间发展的个人联系和相互尊重的基础上。虽然护理标准化有可能减轻实际工作量，并允许更积极和更有成效的面对面联系。未来的CP CDE修订版将以系统的方式纳入更多信息，包括客户视角、首选项和选择，以增强CP CDE版本1.0中当前建议所建议的标准化工具。
EDITOR–The overall aim of the Common Data Elements (CDE) project was to standardize data collection and assessment in studies of children and young people with cerebral palsy (CP). Dr Fairhurst’s commentary raised the following question: can standardized care coexist with personalized care without losing the flexible art of medicine? Standardization promotes the application of evidencebased medicine (or the best available evidence) in a systematic way, to ensure patients receive effective care. We need less variance in clinical practice to achieve more consistent outcomes and improve quality of care and patient safety. On the other hand, personalization of care relies on health professionals knowing their patients well and treating them as unique individuals. Personalization improves the patient experience and increases their engagement and health knowledge. While standardization of clinical care – using universal frameworks, CDEs, toolbox of measures, core sets, care pathways – is valuable to support evidence-based practices, the experience from the child’s and his or her family’s points of view can still be personalized. It is important to note that with standardized care there are still decisions to be made based on the child’s and family’s preferences and choices. Setting goals and priorities for intervention, pain management techniques, and type and time of introduction of assistive technologies are examples where clients’ decision-making takes place to meet their personalized needs. Hence, we can standardize and personalize care at the same time. The recommended CDEs for children and young adults with CP standardize data collection for this population. In CP, standardization and personalization can complement each other. Most importantly, standardization can enhance personalization by eliminating the unnecessary time and cost of using low quality assessment tools, or ignoring opportunities to obtain relevant clinical information, which in turn minimizes complications or inappropriate treatment that does not adhere to best evidence-informed practices. Health professionals often make assessment and treatment decisions based on their unique clinical education and experiences. Standardization compensates for this variation in history and experience and harmonizes assessment, evaluation, and reporting of outcomes, ultimately facilitating informative comparisons across research studies and therapeutic interventions. Finally, we propose that the essence of good empathic care is based on the personal connection and mutual respect developed between health professionals and the child and family. While standardization of care has the potential to relieve actual workload and to allow for more positive and productive in-person connections. Future CP CDE revisions will incorporate additional information that includes client perspectives, preferences, and choices in a systematic way, to enhance the standardized tools proposed by the current recommendations in CP CDEs version 1.0.