Patient Preferences Appropriateness/Gery W. Ryan

患者偏好适当性/Gery W. Ryan

• 批准号: 8573686
• 负责人: Ian Douglass Coulter
• 金额: $ 33.72万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8573686
• 关键词: Address; Aftercare; Age; Attitude; Caring; Characteristics; Chiropractic manipulation; Chiropractor; Chronic neck pain; Communities; Complementary and alternative medicine; Complex; Data; Decision Making; Ensure; Ethics; Family; Friends; Gender; Goals; Health Benefit; Health system; Healthcare; Individual; Interview; Neck Pain; Pain; Pathway interactions; Patient Preferences; Patient-Centered Care; Patients; Physicians; Play; Prevalence; Procedures; Protocols documentation; Provider; Recruitment Activity; Relative (related person); Reporting; Review Literature; Role; Sampling; Series; Severities; Site; Societies; Staging; Structure; Symptoms; Testing; Time; Variant; base; chiropracty; cost; cost effective; cost effectiveness; expectation; experience; insight; patient expectation; patient oriented; payment; preference; satisfaction; success

. Project Description Appropriateness of care is about ensuring that individuals receive care that is (a) clinically effective, (b) cost-effective, and is consistent with (c) ethical principles and (d) preferences relevant to individuals, communities and society. Given the prevalence of patient self-referral in complementary and alternative medicine (CAM) and the health system-wide focus on patient-centered care, it seems reasonable to consider individual preferences when assessing the appropriateness of CAM procedures. Unfortunately, we know very little about CAM users' preferences and decision-making since most CAM studies are conducted at the individual level rather than for specific illness episodes. Using chiropractic manipulation and mobilization (M/M) for chronic cervical pain as an example, this study will explore the role that patients' preferences, expectations and experiences may play in assessing the appropriateness of treatments and procedures. The study will occur in three stages. In the first stage, we will recruit patients suffering from chronic neck pain from chiropractic practices and conduct in-depth, semi-structured interviews about their past and current experiences in treating their neck pain. We will use these interviews, as well as a comprehensive review of the literature; to develop a series of interview protocols for assessing patient decision making, expectations, experiences and satisfaction with their chiropractic care. Next we will pilot test the protocols on 50 chronic cervical pain patients who are currently seeing a chiropractor and make appropriate changes as required. The finalized protocols will then be the basis for collecting data from a national sample of 800 patients with chronic cervical pain from 80 chiropractic practices located in four national sites. These data will provide unprecedented insights into patient preferences, expectations, healthcare experiences and satisfaction with those experiences, reported short- and long-term results and satisfaction with those results and treatment appropriateness. We will also describe how these vary across sociodemographic characteristics, time, initial pain severity and previous experiences with chiropractic, other CAM and other non-CAM treatments. The resulting patient-centered findings will be incorporated into the discussion concerning the appropriateness of utilizing M/M for chronic cervical pain.

。项目描述 护理的适当性是指确保个人接受的护理是 (a) 临床有效、(b) 具有成本效益，并且符合 (c) 道德原则和 (d) 与个人、社区和社会相关的偏好。鉴于补充和替代医学 (CAM) 中患者自我转诊的盛行以及整个卫生系统对以患者为中心的护理的重视，在评估 CAM 程序的适当性时考虑个人偏好似乎是合理的。不幸的是，我们对 CAM 用户的偏好和决策知之甚少，因为大多数 CAM 研究都是在个人层面进行的，而不是针对特定的疾病发作。以治疗慢性颈椎疼痛的脊椎按摩手法和动员 (M/M) 为例，本研究将探讨患者的偏好、期望和经验在评估治疗和手术的适当性方面可能发挥的作用。 该研究将分三个阶段进行。在第一阶段，我们将招募因脊椎按摩治疗而患有慢性颈部疼痛的患者，并对他们过去和现在治疗颈部疼痛的经验进行深入的半结构化访谈。我们将利用这些访谈以及对文献的全面回顾；制定一系列访谈方案，以评估患者的决策、期望、体验以及对脊椎按摩治疗的满意度。接下来，我们将对 50 名目前正在看脊椎按摩师的慢性颈椎疼痛患者进行试点测试，并根据需要进行适当的更改。最终确定的方案将成为从全国四个地点的 80 家脊椎按摩诊所收集 800 名慢性颈痛患者样本的数据的基础。 这些数据将为患者的偏好、期望、医疗保健体验和对这些体验的满意度、报告的短期和长期结果以及对这些结果和治疗适当性的满意度提供前所未有的见解。我们还将描述这些因素如何随着社会人口特征、时间、初始疼痛严重程度以及脊椎按摩疗法、其他 CAM 和其他非 CAM 治疗的经验而变化。由此产生的以患者为中心的研究结果将纳入有关使用 M/M 治疗慢性颈椎疼痛是否合适的讨论中。