Shared Decision Making among Children with Medical Complexity: Results from a Population-Based Survey.
Shared Decision Making among Children with Medical Complexity: Results from a Population-Based Survey.
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DOI：
10.1016/j.jpeds.2017.09.001
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Sanders LM
中科院分区：
文献类型：
--
作者：
Lin JL;Cohen E;Sanders LM
比较医疗复杂性儿童（CMC）父母报告的共同决策（SDM）率与有特殊医疗保健需求的非复杂性儿童（CSHCN）父母报告的SDM率。我们检查了2009-2010年全国有特殊医疗保健需求的儿童调查，这是一项对40，242名CSHCN父母进行的代表性调查。CMC被定义为需要或使用比平时更多的医疗护理，看2个或更多的专科医生，并且在CSHCN筛选器上至少有3个其他项目的阳性反应。我们通过前哨诊断确定了CMC和非复杂性CSHCN的三个亚组：哮喘、癫痫发作和其他诊断。SDM被定义为一个二进制复合变量，来自4个离散的项目。我们构建了四个逐步多变量模型来评估SDM的相对几率，调整了社会人口学特征（年龄，收入，语言，种族，民族，婚姻状况），行为合并症，以家庭为中心的护理和以患者为中心的医疗之家。研究人群包括39，876名受访者。与非复杂性CSHCN相比，CMC发生SDM的可能性较低（校正比值比（aOR）0.76，0.64-0.91），在诊断亚组中持续存在：CMC伴哮喘（aOR 0.67，0.49-0.92），CMC伴其他诊断（aOR 0.74，0.58-0.94）;但CMC不伴癫痫发作（aOR 0.95，0.59-1.51）。与没有复杂需求的CSHCN相比，具有复杂需求的CSHCN的共享决策不太常见。卫生系统的干预措施，以面向未来的护理规划可能会改善SDM CMC。
To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN). We examined the 2009–2010 National Survey of Children with Special Health Care Needs, a representative survey of 40,242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN Screener. We identified three subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed four step-wise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, marital status), behavioral comorbidity, family centered care, and patient centered medical home. The study population included 39,876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (adjusted odds ratio (aOR) 0.76, 0.64–0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR 0.67, 0.49–0.92), CMC with other diagnoses (aOR 0.74, 0.58–0.94); but not CMC with seizures (aOR 0.95, 0.59–1.51). Shared decision making is less common for CSHCN with complex needs than those without complex needs. Health-system interventions targeting future-oriented care planning may improve SDM for CMC.
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影响因子：
26.1
作者：
Berry, Jay G.;Hall, Matt;Hall, David E.;Kuo, Dennis Z.;Cohen, Eyal;Agrawal, Rishi;Mandl, Kenneth D.;Clifton, Holly;Neff, John
通讯作者：
Neff, John
影响因子：
2.4
作者：
Fiks, Alexander G.;Mayne, Stephanie;Guevara, James P.
通讯作者：
Guevara, James P.
影响因子：
8
作者：
Fiks, Alexander G.;Localio, A. Russell;Guevara, James P.
通讯作者：
Guevara, James P.
影响因子：
8
作者：
Cohen, Eyal;Berry, Jay G.;Guttmann, Astrid
通讯作者：
Guttmann, Astrid
影响因子：
3.7
作者：
Durand MA;Carpenter L;Dolan H;Bravo P;Mann M;Bunn F;Elwyn G
通讯作者：
Elwyn G