Patient Activation as a Pathway to Shared Decision-making for Adults with Diabetes or Cardiovascular Disease
Patient Activation as a Pathway to Shared Decision-making for Adults with Diabetes or Cardiovascular Disease
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DOI：
10.1007/s11606-019-05351-6
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发表时间：
2019-10-23
影响因子：
5.7
通讯作者：
Rodriguez, Hector P.
中科院分区：
文献类型：
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作者：
Poon, Bing Ying;Shortell, Stephen M.;Rodriguez, Hector P.
背景共同决策（SDM）被广泛认为是改善以患者为中心的护理的核心策略。然而，SDM在日常护理环境中的实施一直缓慢，其影响好坏参半。目的研究患者激活和患者体验与SDM过程的时间关联，以评估这种关系的主导方向性。设计患者激活，或患者的知识，技能和自我管理的信心，使用13项患者激活措施（PAM）进行评估。使用3项CollaboRATE指标评估患者报告的SDM过程评估。2015年和2016年，对16家成人初级保健机构的患者进行了PAM（α = 0.92）、CollaboRATE（α = 0.90）和人口统计学调查。使用交叉滞后面板模型估计PAM和CollaboRATE之间的关系，该模型具有聚类稳健标准误和实践固定效应，控制患者特征。研究对象为1222名糖尿病和/或心血管疾病的成年患者，基线调查应答率为51%，1年随访应答率为73%。结果PAM（平均值3.27 vs 3.28，范围为1至4; p = 0.082）和CollaboRATE（平均值3.62 vs 3.63，范围为1至5; p = 0.14）没有随着时间的推移发生显着变化。在校正分析中，从基线PAM到随访CollaboRATE的路径（β = 0.35; p < 0.0001）强于从基线CollaboRATE到随访PAM的路径（β = 0.04; p = 0.001）。结论患者激活与患者的SDM过程体验之间的关系是双向的，但受基线患者激活的支配。与其促进所有患者使用SDM，医疗保健组织应优先考虑促进患者激活的干预措施，并在SDM干预措施中吸引激活程度相对较高的患者。
Background Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. Objective We examine the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship. Design Patient activation, or a patients' knowledge, skills, and confidence in self-management, was assessed using the 13-item Patient Activation Measure (PAM). Patient-reported assessment of the SDM process was assessed using the 3-item CollaboRATE measure. Patients at 16 adult primary care practices were surveyed in 2015 and 2016 on PAM (alpha = 0.92), CollaboRATE (alpha = 0.90), and demographics. The relationship between PAM and CollaboRATE was estimated using a cross-lagged panel model with clustered robust standard errors and practice fixed effects, controlling for patient characteristics. Participants 1222 adult patients with diabetes and/or cardiovascular disease with survey responses at baseline (51% response rate) and a 1-year follow-up (73% response rate). Results PAM (mean 3.27 vs 3.28 on a range of 1 to 4; p = 0.082) and CollaboRATE (mean 3.62 vs 3.63 on a range of 1 to 5; p = 0.14) did not change significantly over time. In adjusted analyses, the path from baseline PAM to follow-up CollaboRATE (beta = 0.35; p < 0.0001) was stronger than the path from baseline CollaboRATE to follow-up PAM (beta = 0.04; p = 0.001). Conclusions The relationship between patient activation and patients' experiences of the SDM process is bidirectional, but dominated by baseline patient activation. Rather than promoting the use of SDM for all patients, healthcare organizations should prioritize interventions to promote patient activation and engage patients with relatively high activation in SDM interventions.