Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions
Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions
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DOI：
10.1177/0898264317691166
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发表时间：
2018-06-01
影响因子：
2.8
通讯作者：
Tinetti, Mary E.
中科院分区：
文献类型：
--
作者：
Ferris, Rosie;Blaum, Caroline;Tinetti, Mary E.
目的：确定多个利益相关者对患有多种慢性病的老年人不适当护理的贡献者的观点。方法：有目的地抽样的36名患者，临床医生，卫生系统和付款人的观点被引出。数据分析遵循恒定的比较方法。结果：触发负担和碎片化的结构性因素包括基于疾病的质量指标，需要与多名临床医生互动。确定的关键文化障碍是医生最了解的假设。不适当的决策可能是由于不注意权衡和遵守多种疾病指南。利益相关者建议改变文化、结构和决策。护理选择和质量指标应反映对患者优先事项的关注。临床医生与患者的伙伴关系应该反映出患者知道他们的健康目标，临床医生知道如何实现这些目标。获得专业知识不应要求访问。讨论内容：利益相关者的建议建议重新设计医疗保健，将患者的健康优先事项纳入护理决策，并重新调整患者和临床医生之间的关系。
Objective: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Method: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Results: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that physicians know best. Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Discussion: Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.