Providers contextualise care more often when they discover patient context by asking: meta-analysis of three primary data sets
Providers contextualise care more often when they discover patient context by asking: meta-analysis of three primary data sets
复制标题
DOI：
10.1136/bmjqs-2015-004283
复制
发表时间：
2016-03-01
影响因子：
5.4
通讯作者：
Weaver, Frances M.
中科院分区：
文献类型：
--
作者：
Schwartz, Alan;Weiner, Saul J.;Weaver, Frances M.
目的以病人为中心的护理的一个重要组成部分是提供者纳入病人的背景因素，生活环境相关的照顾，在管理病人的健康。目前的研究使用的数据集收集的直接观察的护理检查，如果提供者如何学习上下文信息的影响是否提供者将信息纳入一个护理计划。方法三个数据集进行了重新分析：一项研究与医生，质量改进项目与医生和性能测量项目与电话健康助理。在每个数据集中，调查人员计算患者背景因素纳入护理计划的比率，其中因素是由提供者响应于探测而引起的，而不是由患者自发揭示的。我们报告的利率，CI和相关的OR为每项研究和整体使用随机效应meta analysis.Results供应商引出了57%，49%和30%的患者上下文的因素，在每个数据集的遭遇。与患者自发发现的相关因素相比，通过探头识别的患者相关因素更频繁地被纳入护理计划（分别为68% vs 46%，71% vs 54%和93% vs 77%）。当因素被探测与自发发现时，将患者背景因素纳入护理计划的总结OR为4.16（95% CI 2.0至8.6）。虽然该估计值与显著异质性相关（I-2=76%），但单个数据集的OR为2.53（1.4至4.5）、6.25（4.9至8.0）和4.2（0.9至19.3）。结论在处理患者背景因素可能在护理决策中发挥重要作用的情况下，由提供者主动引出的因素比由患者自发揭示的因素更可能被纳入护理计划中。与提供者表现相关的护理过程中的这些差异只能通过直接观察来证明。
Objectives One important component of patient-centred care is provider incorporation of patient contextual factors-life circumstances relevant to their care-in managing the patient's health. The current study uses data sets collected from direct observation of care to examine if how a provider learns contextual information influences whether the provider incorporates the information into a care plan.Methods Three data sets were reanalysed: a research study with physicians, a quality improvement project with physicians and a performance measurement project with telephone health assistants. In each data set, investigators compute rates of incorporation of patient contextual factors into the care plan for encounters in which factors were elicited in response to a probe by the provider versus revealed spontaneously by the patient. We report the rates, CIs and associated ORs for each study and overall using a random effects meta-analysis.Results Providers elicited 57%, 49% and 30% of patient contextual factors identified in encounters in each data set. Patient contextual factors identified in response to probes were incorporated into the plan of care more frequently than those revealed spontaneously by patients (68% vs 46%, 71% vs 54% and 93% vs 77%, respectively). The summary OR for incorporation of patient contextual factors into the care plan when the factor was probed versus revealed spontaneously was 4.16 (95% CI 2.0 to 8.6). While this estimate was associated with significant heterogeneity (I-2=76%), the ORs for the individual data sets were 2.53 (1.4 to 4.5), 6.25 (4.9 to 8.0) and 4.2 (0.9 to 19.3).Conclusions In encounters where addressing patient contextual factors may play an important role in care decisions, factors that are elicited actively by the provider are more likely to be incorporated in the care plan than factors revealed spontaneously by the patient. These differences in the care process associated with provider performance can only be demonstrated through direct observation.