Medical Decision-Making and Network Assembly Mechanisms in Inpatient Surgical Care

住院外科护理中的医疗决策和网络组装机制

• 批准号: 1560987
• 负责人: Jason Owen-Smith
• 金额: $ 34.93万
• 依托单位: Regents of the University of Michigan - Ann Arbor
• 依托单位国家: 美国
• 项目类别: Continuing Grant
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1560987&HistoricalAwards=false
• 关键词: Medical; Decision; Making; Network; Assembly

Inpatient surgical care largely relies on teamwork. A single patient will see many doctors and other care providers over the course of pre- and postoperative care. The surgery itself also involves multiple surgeons and other caregivers. The relationships that develop as physicians work together during the surgical care process create teamwork networks that have important implications for the quality and efficiency of care. This research will observe and interview physicians, nurses, and other caregivers about their work and the treatment decisions that they make around inpatient surgical procedures. This information will be used to systematically examine how collaborative networks evolve and change in hospitals. This research will inform efforts to improve the quality and reduce the costs of surgical care while providing new insights into important social science questions about how these kinds of networks form and grow.In the last two decades social scientific research on networks has undergone a dramatic transformation as new data and methods have enabled a shift toward dynamic analysis. At the same time, work in the fields of organizational theory, economic, and cultural sociology has emphasized the contingent and situational nature of relationships, structures, and their effects. While networks of various sorts have been shown to influence individual and collective outcomes in a wide range of substantive areas, the linkages between micro network dynamics, macro network structures, and their effects have yet to be fully specified. This research will take important steps toward explaining the formation and effects of a substantively important class of networks by examining the ways in which organizational arrangements, individual choices, and existing relationships shape physicians' treatment decisions and ultimately the health of larger patient populations in individual hospitals and broader healthcare markets. This mechanism-based approach to understanding how physician relationships form, reproduce, and change in particular organizations and treatment situations integrates work on the collective dynamics of large-scale networks with theories that emphasize the organizational and institutional contexts in which relationships emerge, gain meaning, and exert their effects. The theoretically anchored, observational, and interview-based field work that we propose herein seeks to clarify the complicated processes by which networks evolve while identifying specific mechanisms, scope conditions, and contingencies that span individual preferences, structural pressures, and organizational constraints or opportunities.

住院外科护理主要依赖于团队合作。在术前和术后护理过程中，单个患者会看到许多医生和其他护理提供者。手术本身还涉及多个外科医生和其他护理人员。 随着医生在外科护理过程中共同努力的关系创造了团队合作网络，对护理的质量和效率具有重要意义。这项研究将观察和采访医生，护士和其他护理人员的工作以及他们围绕住院手术程序做出的治疗决定。该信息将用于系统地检查医院的协作网络如何发展和变化。这项研究将为提高质量并降低外科护理成本的努力提供帮助，同时为有关这些类型的网络如何形成和发展的重要社会科学问题提供新的见解。在过去的二十年中，社会科学研究在网络上进行了巨大的转变，因为新数据和方法使动态分析的转变使得新数据和方法的转变。同时，在组织理论，经济和文化社会学领域的工作强调了关系，结构及其影响的偶然性和情境性质。尽管已经显示出各种各种各样的网络会影响各种实质领域的个人和集体成果，但微网络动态，宏网络结构及其效果之间的联系尚未完全指定。这项研究将通过研究组织安排，个人选择和现有关系的方式来解释实质上重要的网络的形成和影响的重要步骤，并最终塑造了医师的治疗决策，并最终塑造了各个医院和更广泛的医疗保健市场中较大的患者人群的健康。这种基于机制的方法来理解医师关系如何形成，在特定组织和治疗情况下如何形成和变化，将大规模网络的集体动态的工作与强调组织和机构背景的理论相结合，在这些理论中，关系出现，获得含义并发挥其影响。 我们在此提出的理论锚定，观察和基于访谈的现场工作旨在阐明网络发展的复杂过程，同时识别涵盖个人偏好，结构压力以及组织约束或机会或机会的特定机制，范围条件和意外事件。