AMA journal of ethics最新文献

This illustration represents how a patient's view of themselves can be altered while going through iatrogenic trauma.

This article draws on opinions in the AMA Code of Medical Ethics and applies them to evidence-based practice.

Electronic health records (EHRs) have revolutionized the scale, speed, and granularity at which health data can be collated and summarized for epidemiologic purposes. However, population-level analyses of patient-level data are only as reliable as the accuracy or completeness of patient reporting, clinician data entry, and how systems are programmed. This commentary on a case argues that responsibility for the validity of EHR data should be shared among key stakeholders, including patients. This commentary also proposes models for EHR data inquiry, data entry, and review processes that incorporate roles of community partners, frontline clinicians, and health science experts.

Coded health care data from patients' health records are used in epidemiological research, especially on incidence or prevalence of disease; for drug safety monitoring or long-term cohort tracking; and to inform policy making. This article briefly summarizes the evolution of internationally recognized coding ontologies and nomenclature and describes applications of coded electronic health record (EHR) data in day-to-day health care operations, research, auditing, and policy development. This article also illuminates how errors can occur when EHR information is coded, considers errors' consequences, and suggests strategies for mitigating errors and improving overall use of coded EHR data.

The establishment of the American Medical Association in 1847 launched medical practice standardization in the United States. Consensus on standards was hard won, however, and implementation was not immediate. Hospital design standards, specifically, were debated for decades and were ultimately ceded to nurses and architects. This article describes key moments along that trajectory.

When built environments in health care result from an evidence-based design (EBD) process, they are interventions that can improve patients' health outcomes. This commentary on a case discusses which ethical values should guide organizations' capital expenditure decisions about retrofits, which might be more costly than the original budget. This discussion urges reevaluation of the common assumption that capital improvements are "sunk costs," since such improvements can promote long-term positive health outcomes for an organization's patients, thereby advancing both financial value and ethical values. This commentary also suggests that EBD offers key interventions that are clinically and ethically relevant.

This commentary on a case considers how and by whom decisions about health care structures and spaces should be made and suggests merits and drawbacks of shared decision-making as one approach to Certificate of Need assessments.

Hostile design is a built environment strategy to discourage unwanted behaviors or limit use by unwanted users in a space. This commentary on a case identifies how hostile design choices perpetuate spatial injustice in both health care settings and the surrounding community and argues that health care organizations have duties to mitigate adverse health consequences of such spatial injustices. This commentary then describes strategies for identifying overt and covert hostile design of health care spaces and proposes future practices and translational research to make health care environments' designs accessible, approachable, and more just.

Since the 1980s, science about how built environments influence human health has been used by architects, engineers, and designers to inform decisions about health care organizations' structures and spaces. Because design influences health outcomes, ignoring evidence-based design can be a source of clinical, ethical, legal, and organizational liability. This article introduces concepts related to designs' influence on patient and community health outcomes and suggests strategies for health-legal partnering to promote rigor in health care organizational design practices that promote quality and equity in health service delivery.