Shared decision making and behavioral impairment: a national study among children with special health care needs
Shared decision making and behavioral impairment: a national study among children with special health care needs
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DOI：
10.1186/1471-2431-12-153
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发表时间：
2012-09-21
期刊：
影响因子：
2.4
通讯作者：
Guevara, James P.
中科院分区：
文献类型：
--
作者：
Fiks, Alexander G.;Mayne, Stephanie;Guevara, James P.
背景资料：医学研究所已经优先考虑了共同决策（SDM），但人们对SDM随着时间的推移对儿童行为结果的影响知之甚少。本研究探讨了SDM与行为障碍的儿童与特殊卫生保健需要（CSHCN）的纵向关联。方法：在2002-2006年的医疗费用面板调查中，对5-17岁的CSHCN进行了为期2年的随访。经验证的哥伦比亚损伤量表测量损伤。SDM测量有7个项目，涉及SDM的4个组件。主要暴露量为（1）2个研究年内SDM的平均水平和（2）2年内SDM的变化。使用线性回归，我们测量了关联的SDM和behavioral impairment.Results：在2,454名受试者代表1020万CSHCN中，SDM增加了37%的人口，减少了36%，保持不变的27%。对于基线时受损的CSHCN，SDM的变化具有显著性，SDM随时间推移每增加1分，损伤减少2分（95% CI：0.5，3.4），而SDM的平均水平与损伤无关。相反，在低于损伤阈值的那些中，SDM的平均水平是显著的，SDM的平均水平每增加一个点，与损伤减少1.1个点相关（0.4，1.7），但变化与损害无关。结论：虽然SDM的变化可能对行为障碍儿童更重要，而对于低于障碍阈值的儿童，随着时间的推移，平均水平可能更重要，结果表明，SDM和平均水平的变化可能会影响CSHCN的行为健康。
Background: The Institute of Medicine has prioritized shared decision making (SDM), yet little is known about the impact of SDM over time on behavioral outcomes for children. This study examined the longitudinal association of SDM with behavioral impairment among children with special health care needs (CSHCN).Method: CSHCN aged 5-17 years in the 2002-2006 Medical Expenditure Panel Survey were followed for 2 years. The validated Columbia Impairment Scale measured impairment. SDM was measured with 7 items addressing the 4 components of SDM. The main exposures were (1) the mean level of SDM across the 2 study years and (2) the change in SDM over the 2 years. Using linear regression, we measured the association of SDM and behavioral impairment.Results: Among 2,454 subjects representing 10.2 million CSHCN, SDM increased among 37% of the population, decreased among 36% and remained unchanged among 27%. For CSHCN impaired at baseline, the change in SDM was significant with each 1-point increase in SDM over time associated with a 2-point decrease in impairment (95% CI: 0.5, 3.4), whereas the mean level of SDM was not associated with impairment. In contrast, among those below the impairment threshold, the mean level of SDM was significant with each one point increase in the mean level of SDM associated with a 1.1-point decrease in impairment (0.4, 1.7), but the change was not associated with impairment.Conclusion: Although the change in SDM may be more important for children with behavioral impairment and the mean level over time for those below the impairment threshold, results suggest that both the change in SDM and the mean level may impact behavioral health for CSHCN.