Understanding Patients' Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery.
Understanding Patients' Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery.
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DOI：
10.1177/10497323211002479
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发表时间：
2021-07
影响因子：
3.2
通讯作者：
Stitzenberg K
中科院分区：
文献类型：
--
作者：
Lumpkin ST;Harvey E;Mihas P;Carey T;Fichera A;Stitzenberg K
结直肠手术（CRS）后的再入院和急诊（艾德）访视是常见的、繁重的和昂贵的。有效的策略，以减少这些计划外出院后的医疗保健访问需要一个细致入微的了解如何以及为什么病人作出决定，寻求照顾。我们使用了一个有目的的分层样本的18个访谈参与者从一个前瞻性队列的成年CRS患者。13名（72%）参与者接受了计划外的出院后医疗保健访视。参与者的决策进行了分类的方法（算法，引导，或冲动），预先存在的理由，和情绪反应感知的医疗保健需求。参与者表达了关于何时访问ED的清晰的心理算法。此外，参与者确定了最佳医疗保健使用的促进者和障碍。他们还确定了减少医疗保健利用的具体目标，例如通过简化出院指示改善护理协调，以及改善与手术团队的沟通。应努力改善出院后的沟通和护理协调，以减少CRS患者的高资源卫生保健利用。
Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients’ high-resource health care utilization.
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