Navigating the evidentiary turn in public health: Sensemaking strategies to integrate genomics into state-level chronic disease prevention programs.
Navigating the evidentiary turn in public health: Sensemaking strategies to integrate genomics into state-level chronic disease prevention programs.
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引导公共卫生的证据转向：将基因组学纳入州级慢性病预防计划的意义建构策略。
DOI：
10.1016/j.socscimed.2018.06.026
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Tan,Catherine
中科院分区：
文献类型：
--
作者：
Senier,Laura;Smollin,Leandra;Lee,Rachael;Nicoll,Lauren;Shields,Michael;Tan,Catherine
在过去的十年中，医疗保健服务面临着两个主要的破坏：人类基因组的映射和循证实践的兴起。社会学家已经记录了医学中循证实践的范式转变，但尚未研究其对其他卫生专业或更广泛的医疗保健竞技场的影响。本文展示了循证实践如何改变美国的公共卫生。我们提出了一个深入的访谈，人种学和档案数据的定性分析，以显示密歇根州的公共卫生机构如何导航转向循证实践，因为他们已经整合了基因组学的科学进步到他们的慢性病预防规划。借鉴组织理论，我们展示了他们如何管理模糊性，通过一个组合的意义给予和意义制造活动。具体而言，他们将基因组学的新发展与长期接受的公共卫生规划模型（核心公共卫生功能）联系起来。这使得国家卫生机构的同行们更熟悉基因组学的前沿进展。他们还整理了州特定的监测数据，以说明密歇根州遗传性癌症的公共卫生负担，并使专家小组对遗传筛查的建议更具本地相关性。最后，他们调动专业知识，帮助其内部同事和外部合作伙伴实现慢性病预防方面传统公共卫生活动的现代化。我们的研究结果表明，组织社会学的工具和概念可以帮助医学社会学家了解循证实践是如何塑造医疗竞技场的机构和专业间的关系。
In the past decade, healthcare delivery has faced two major disruptions: the mapping of the human genome and the rise of evidence-based practice. Sociologists have documented the paradigmatic shift towards evidence-based practice in medicine, but have yet to examine its effect on other health professions or the broader healthcare arena. This article shows how evidence-based practice is transforming public health in the United States. We present an in-depth qualitative analysis of interview, ethnographic, and archival data to show how Michigan's state public health agency has navigated the turn to evidence-based practice, as they have integrated scientific advances in genomics into their chronic disease prevention programming. Drawing on organizational theory, we demonstrate how they managed ambiguity through a combination of sensegiving and sensemaking activities. Specifically, they linked novel developments in genomics to a long-accepted public health planning model, the Core Public Health Functions. This made cutting edge advances in genomics more familiar to their peers in the state health agency. They also marshaled state-specific surveillance data to illustrate the public health burden of hereditary cancers in Michigan, and to make expert panel recommendations for genetic screening more locally relevant. Finally, they mobilized expertise to help their internal colleagues and external partners modernize conventional public health activities in chronic disease prevention. Our findings show that tools and concepts from organizational sociology can help medical sociologists understand how evidence-based practice is shaping institutions and interprofessional relations in the healthcare arena.
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