Professionalism & Rationalization of Clinical Processes

描述（由申请人提供）：护理质量不佳和医疗费用飙升一直是美国医疗保健系统的长期问题。制定了合理化临床实践的措施，如正式的临床指南和计算机化的决策支持工具，以提高护理质量和控制成本。医疗保健过程合理化的重要性一直呈指数增长。然而，经验证据表明，合理化的过程并不一贯利用在临床实践中，其对医生的行为的影响是可变的。有人认为，合理化的过程会侵犯医生的自主权，因此会引起抵制。为什么医生的自主权受到合理化过程的负面影响？所有的医生都对合理化流程有相同的看法吗？不同类型的合理化过程对医生自主性的影响程度相同吗？该项目建议使用社区跟踪研究（CTS）医生调查的定量数据和对36名医生的定性访谈来解决这些问题。拟议的研究旨在检查合理化过程对医生自主性的影响是否因合理化过程的类型而异，以及不同类型的合理化过程是否会在不同程度上影响医生自主性。它还旨在了解医生的专业工作和自主权的概念如何影响他们的态度和合理化过程的做法。候选人提出，医生的专业工作和自主权的概念，这是来自医疗专业精神的核心价值观，影响医生对临床实践合理化的态度，从而影响他们的合理化过程的做法。医生可能会因其专业训练、社会化程度以及在专业和医疗系统中的不同地位而采用不同的概念，并形成不同的态度和合理化过程的采用行为。合理化过程的类型也可能对合理化过程的态度如何影响采用行为产生不同的影响。

DESCRIPTION (provided by the applicant): Suboptimal quality of care and soaring medical costs have been perennial problems in the U.S. healthcare system. Measures that rationalize clinical practices, such as formal clinical guidelines and computerized decision support tools, were developed to improve quality of care and control costs. The prominence of rationalizing processes in healthcare has been growing exponentially. However, empirical evidence shows that rationalizing processes are not consistently utilized in clinical practice, and their effects on physician behavior are variable. It has been suggested that rationalizing processes impinge on physician autonomy and hence provoke resistance. Why is physician autonomy negatively affected by rationalizing processes? Do all physicians feel the same about rationalizing processes? Do different types of rationalizing processes influence physician autonomy to the same degree? This project proposes to address these issues using quantitative data from the Community Track Study (CTS) Physician Survey and qualitative interviews with 36 physicians. The proposed study seeks to examine if the effects of rationalizing processes on physician autonomy vary by types of rationalizing processes, and if different types of rationalizing processes influence physician autonomy to different degrees. It also aims to understand how physicians' conceptions of professional work and autonomy influence their attitudes towards and practices of rationalizing processes. The candidate proposes that physicians' conceptions of professional work and autonomy, which are derived from core values in medical professionalism, influence physicians' attitudes towards rationalization of clinical practices, and thereby impact upon their practices of rationalizing processes. Contingent upon their professional training and socialization and differential positions within the profession and healthcare system, physicians might adopt different conceptions and develop different attitudes and adoption behavior of rationalizing processes. Types of rationalizing processes might also have differential effects on how attitudes towards rationalizing processes influence adoption behavior.