Journal of hospital management and health policy最新文献_第9页

Cost of inappropriate use of intravenous N-acetylcysteine for acetaminophen toxicity 静脉注射N-乙酰半胱氨酸治疗对乙酰氨基酚毒性的费用

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/JHMHP-20-87

A. Dalabih, C. Cox, Jordan Anderson

study Background: Intravenous (IV) N-acetylcysteine (NAC) is the treatment of choice for acetaminophen (APAP) toxicity. The initiation of NAC should be based on specific criteria depicted by the Rumack-Matthew Nomogram. The treatment requires hospital admission and frequent laboratory tests, making it a costly treatment. The purpose of this analysis is to determine the financial impact of inappropriate IV NAC use for APAP toxicity. Methods: This single-center, retrospective chart review included adult and pediatric subjects who received at least one dose of IV NAC at a tertiary academic medical center for acute and chronic APAP toxicity. Primary objective; determine the financial impact of inappropriate use of IV-NAC concerning compliance with the nomogram when initiating the treatment. Secondary objectives; missed cost-saving opportunities resulting from non-compliance with treatment regimen recommendations for maximum doses, and the number of dosing cycles. Cost analysis was completed by the hospital billing department and utilized true cost charges. Total cost of hospitalization was calculated, and total medication charges were evaluated separately using the hospital’s group purchasing organization (GPO) pricing. Results: Ninety-six subjects were included in the final analysis. A potential savings of $253,891.85 United States Dollars (USD) could have been realized if the administration guidelines were followed. NAC was inappropriately initiated in 20 of the 56 subjects (35.7%) with an acute, known time of APAP ingestion. Of the 346 total doses of IV NAC administered throughout the study (n=47, 13.6%) exceeded manufacturer maximum suggested recommendations. The higher doses were all related to subjects with body weight higher than 100 kg. Conclusions: The results from this study show a high financial cost on the healthcare system when providers inappropriately initiate IV NAC for acute APAP toxicity. Healthcare systems should follow the administration guidelines of IV NAC to decrease overall expenses and potential adverse effects. Utilizing order sets to guide appropriate therapy initiation and/or discontinuation is advisable. A careful review of pertinent laboratory values and collaboration with regional Poison Control Centers to determine treatment duration may also be warranted.

研究背景:静脉注射n -乙酰半胱氨酸(NAC)是治疗对乙酰氨基酚(APAP)毒性的首选方法。NAC的启动应该基于Rumack-Matthew Nomogram所描述的特定标准。治疗需要住院和频繁的实验室检查，使其成为一种昂贵的治疗方法。本分析的目的是确定不适当IV NAC用于APAP毒性的财务影响。方法:这项单中心、回顾性图表综述包括在三级学术医疗中心接受至少一剂静脉NAC治疗急性和慢性APAP毒性的成人和儿童受试者。主要目标;确定在开始治疗时不适当使用IV-NAC对依从性的财务影响。次要目标;由于不遵守治疗方案建议的最大剂量和给药周期数，错过了节省成本的机会。成本分析由医院计费部门完成，采用真实成本收费。计算住院总费用，采用医院团购组织(GPO)定价分别评估总用药费用。结果:96名受试者纳入最终分析。如果执行行政指导方针，可能节省253,891.85美元。56例受试者中有20例(35.7%)出现急性、已知APAP摄入时间的NAC不适当启动。在整个研究过程中，静脉注射NAC的346个总剂量(n=47, 13.6%)超过了制造商建议的最大剂量。较高的剂量均与体重高于100公斤的受试者有关。结论:本研究的结果表明，当提供者不适当地开始静脉NAC治疗急性APAP毒性时，医疗保健系统的财务成本很高。医疗保健系统应遵循静脉NAC的管理指南，以减少总费用和潜在的不良反应。建议使用指令集来指导适当的治疗开始和/或停止。仔细审查相关的实验室值，并与区域毒物控制中心合作，以确定治疗时间也是必要的。

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引用次数: 2

Use of a Key Drivers Diagram in preparation for COVID-19 at an urban, academic anesthesiology department 在城市学术麻醉科准备COVID-19时使用关键驱动图

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/jhmhp-21-5

K. Parr, Geoffrey Ho, Michelle S. Burnette, James Gould, B. Petinaux, M. Sherman, Jeffrey S. Berger

Background: The 2019 novel coronavirus pandemic has had a significant impact on anesthesiology practice globally. Its high infectivity and severity of onset has led to numerous examples of healthcare systems being overwhelmed, especially at its incipience. Drawing on experiences from previous pandemics, we anticipated that our Anesthesiology Department would be faced with unique challenges due to our proximity to airway maneuvers. We set out to intentionally strategize a quality improvement framework with which to guide our departmental response. Methods: We employed a Key Drivers Diagram (KDD) model to strategically account for the numerous novel quality improvement measures implemented simultaneously in response to the pandemic. Having identified areas of interest, measurable indices were identified, and dynamic progress assessed using run charts. These were (I) protect patients and staff, (II) keep up-to-date with evolving evidence, (III) maintain communication with department, (IV) keep staff engaged, and (V) align departmental goals with institutional aims. Results: Positive trends in staff engagement were identified across participation in educational activities such as guideline development, grand round attendance, and interdepartmental meetings. Conclusions: The KDD provided a valuable framework for managing parallel quality improvement processes. It enabled leadership to identify needs, measure adequacy of response and implement changes in a rapidly evolving environment. © Journal of Hospital Management and Health Policy. All rights reserved.

背景：2019年新型冠状病毒大流行对全球麻醉实践产生了重大影响。它的高传染性和发病的严重性导致了许多医疗系统不堪重负的例子，尤其是在刚开始的时候。根据以往流行病的经验，我们预计，由于我们接近气道操作，我们的麻醉科将面临独特的挑战。我们开始有意制定一个质量改进框架，以指导我们的部门反应。方法：我们采用了关键驱动因素图（KDD）模型，从战略上解释了为应对疫情而同时实施的许多新的质量改进措施。在确定了感兴趣的领域后，确定了可衡量的指数，并使用运行图评估了动态进展。这些措施包括：（I）保护患者和工作人员，（II）及时了解不断发展的证据，（III）与部门保持沟通，（IV）保持员工参与，以及（V）使部门目标与机构目标保持一致。结果：在参与指导方针制定、大圆桌会议和部门间会议等教育活动方面，发现了员工参与度的积极趋势。结论：KDD为管理并行质量改进过程提供了一个有价值的框架。它使领导层能够确定需求，衡量应对措施的充分性，并在快速发展的环境中实施变革。©《医院管理与健康政策杂志》。保留所有权利。

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引用次数: 0

Technological advances to enhance recovery after cardiac surgery 提高心脏手术后恢复能力的技术进步

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/JHMHP-20-114

K. Lobdell, J. Appoo, G. Rose, B. Ferguson, S. Chatterjee

Surgery, and especially cardiac surgery, is common, costly, and entails considerable risk. Significant progress has been made in recent years to improve quality, promote patient safety, and increase value and cost-effectiveness in surgical care. Enhanced Recovery After Surgery (ERAS) initiatives are increasing in popularity, improving outcomes, and enriching patient satisfaction. First developed for abdominal surgical cases, ERAS has increasingly established itself across all surgical subspecialities, including cardiac surgery. ERAS focuses on evidence-based initiatives in the preoperative, intraoperative, and postoperative phases of care to promote patient well-being and efficient care. The deliberate, judicious incorporation of technology into surgery and the periprocedural home has tremendous, revolutionary potential in all phases of care and is consistent with ERAS principles. This technology can be harnessed by physicians and the care provider team, the healthcare system, and perhaps most importantly, by patients themselves to lead to a higher level of engagement. We will explore technology's transformational capability by concentrating on cardiac surgery because of its prevalence, costs, risks, and contribution to the healthcare system's bottom line. In addition, the role that ERAS combined with technology can play in a constructive manner will be important. We discuss the disruptive effect that the COVID-19 pandemic offers to accelerate these developments. While the human cost of the pandemic has been staggering, in the post-COVID world, the lessons learned can be vital. Finally, we seek to show that the opportunities technology provides are closely related to what both patients and the physician and provider teams want. As technology inevitably becomes more integrated into healthcare, the ability to harness technology to maximize patient outcomes and well-being while promoting more efficient healthcare delivery will be critical. © Journal of Hospital Management and Health Policy. All rights reserved.

手术，尤其是心脏手术，是常见的，昂贵的，并带来相当大的风险。近年来，在提高外科护理质量、促进患者安全、提高价值和成本效益方面取得了重大进展。增强术后恢复（ERAS）计划越来越受欢迎，改善了结果，丰富了患者满意度。ERAS最初是为腹部外科病例开发的，它在包括心脏外科在内的所有外科亚专业中都有越来越多的地位。ERAS专注于术前、术中和术后护理阶段的循证举措，以促进患者健康和高效护理。将技术深思熟虑、明智地纳入手术和围手术期家庭在护理的各个阶段都具有巨大的革命性潜力，并且符合ERAS原则。医生和护理人员团队、医疗系统，也许最重要的是，患者自己可以利用这项技术来提高参与度。我们将通过专注于心脏手术来探索技术的转型能力，因为它的流行性、成本、风险以及对医疗系统底线的贡献。此外，电子逆向拍卖与技术相结合可以发挥建设性的作用，这将是重要的。我们讨论了新冠肺炎大流行对加速这些发展的破坏性影响。尽管新冠肺炎疫情造成的人力成本令人震惊，但在后新冠肺炎时代，吸取的教训可能至关重要。最后，我们试图表明，技术提供的机会与患者、医生和提供者团队的需求密切相关。随着技术不可避免地与医疗保健更加融合，利用技术最大限度地提高患者的结果和幸福感，同时促进更高效的医疗保健服务的能力将至关重要。©《医院管理与健康政策杂志》。保留所有权利。

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引用次数: 2

Patient and family advisory councils (PFAC) feedback as the voice of health care consumers 患者和家属咨询委员会(PFAC)的反馈作为卫生保健消费者的声音

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/jhmhp-20-112

Cortney D Forward, Cynthia J. Sieck

Background: Throughout the U.S., healthcare organizations continuously find ways to incorporate patient feedback with efforts to advance the delivery of patient-centered care. Patient and family advisory councils (PFACs) can be used as a strategy to better understand and honor the patient experience and improve care delivery thanks to patient input to obtain patient perspectives. The importance of formal efforts to incorporate the patient perspective is highlighted by the Comprehensive Primary Care Plus (CPC+) program implemented by the Centers for Medicare and Medicaid Services which requires organizations to establish PFACs to receive funding. Site support for PFACs included a patient experience manager who oversaw recruitment and facilitated each clinic’s council meetings. Other support personnel consisted of the practice manager, physicians, care coordinators, and advanced practice providers. This study employed a leadership framework to better understand how health care organizations use PFACs to discover and define patient/family advisors perspectives and how they can be related to different styles of leadership continually evolving. This study surrounding the experiences of patient/family advisors and PFACs can be used for further research and to gain a better understanding of this topic. This research presented patient/ family advisors experiences, working together on patient family advisory councils with health care leaders, staff, providers, and managers, signaling the distinctive experiences of these participants which merits additional examination. There is further need for a meaningful discussion concerning the distinctive way doctors, providers and patients perceive the importance and meaning of medical encounters and patient and family engagement strategies.

背景:在整个美国，医疗保健组织不断寻找方法，将患者反馈与努力推进以患者为中心的护理相结合。患者和家属咨询委员会(PFACs)可以作为一种策略，更好地理解和尊重患者的经验，并通过患者的意见来改善护理服务，以获得患者的观点。由医疗保险和医疗补助服务中心实施的综合初级保健+ (CPC+)项目强调了正式努力纳入患者观点的重要性，该项目要求各组织建立PFACs以获得资金。PFACs的现场支持包括一名患者体验经理，他负责监督招聘并促进每个诊所的理事会会议。其他支持人员包括实践经理、医生、护理协调员和高级实践提供者。本研究采用了一个领导力框架来更好地理解医疗机构如何使用PFACs来发现和定义患者/家庭顾问的观点，以及它们如何与不断发展的不同风格的领导相关联。本研究围绕患者/家庭顾问和PFACs的经验进行，可以用于进一步的研究，并更好地理解这一主题。本研究展示了患者/家庭顾问的经验，与医疗保健领导者、员工、提供者和管理人员一起在患者家庭咨询委员会工作，表明这些参与者的独特经验值得进一步研究。还需要就医生、提供者和患者对医疗接触的重要性和意义以及患者和家庭参与战略的独特看法进行有意义的讨论。

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引用次数: 1

Hospital value-based purchasing, market competition, and outpatient imaging efficiency 医院价值采购、市场竞争与门诊影像效率

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/JHMHP-20-127

Mei Zhao, H. Hamadi, D. R. Haley, K. Pray, Paul A. Heyliger-Fonseca, A. Spaulding

Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, FL, USA; Management Engineering and Internal Consulting, Mayo Clinic in Rochester, Rochester, MN, USA; Defense Health Agency Supporting Navy, San Antonio, TX, USA; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA Contributions: (I) Conception and design: M Zhao, DR Haley, A Spaulding; (II) Administrative support: K Pray, DR Haley, P Heyliger-Fonseca; (III) Provision of study materials or patients: M Zhao, HY Hamadi, A Spaulding, P Heyliger-Fonseca; (IV) Collection and assembly of data: HY Hamadi, M Zhao, A Spaulding, K Pray; (V) Data analysis and interpretation: M Zhao, HY Hamadi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Hanadi Y. Hamadi, PhD, MHA. Associate Professor, Department of Health Administration, Brooks College of Health, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224-7699, USA. Email: h.hamadi@unf.edu.

美国佛罗里达州杰克逊维尔北佛罗里达大学布鲁克斯健康学院卫生管理系；美国明尼苏达州罗切斯特市梅奥诊所管理工程和内部咨询；美国得克萨斯州圣安东尼奥市支持海军的国防卫生局；美国佛罗里达州杰克逊维尔梅奥诊所医疗保健政策与研究部卫生科学研究部Robert D.和Patricia E.Kern医疗保健提供科学中心贡献：（I）构思与设计：M赵，Haley博士，A Spaulding；（II）行政支持：K Pray、Haley博士、P Heylger Fonseca；（III）提供研究材料或患者：M赵、HY Hamadi、A Spaulding、P Heyliger-Fonseca；（IV）数据收集和汇编：HY Hamadi，M赵，A Spaulding，K Pray；（V）数据分析与解释：M赵，HY Hamadi；（VI）手稿写作：所有作者；（VII）手稿的最终批准：所有作者。通信：Hanadi Y.Hamadi，博士，MHA。北佛罗里达大学布鲁克斯健康学院卫生管理系副教授，地址：1 UNF Drive，Jacksonville，FL 32224-7699，USA电子邮件：h.hamadi@unf.edu.

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引用次数: 1

Challenges in the implementation of electronic systems for patient report of symptoms in oncology: a scoping review. 肿瘤患者症状报告电子系统实施中的挑战:范围审查

Journal of hospital management and health policy

Pub Date : 2021-01-01 Epub Date: 2021-09-25 DOI: 10.21037/jhmhp-20-108

Stacey Crane, Karen DiValerio Gibbs, Rebecca Nosich, Yijiong Yang, Elizabeth Pawelek

Background: Under-recognition and under-treatment of symptoms are prevalent throughout the health care system in the United States. While the reasons for this are complex, it is widely recognized that electronic symptom reports can improve clinicians' ability to manage symptoms. However, electronic symptom reporting has yet to be widely implemented. Electronic systems are most effective when tailored to the specific patient population or clinical setting. For example, numerous oncology-focused electronic symptom reporting systems have been developed for patients with cancer undergoing treatment in the United States. The objective of this scoping review was to identify challenges that arose in the implementation of electronic systems for patient-reported symptoms in oncology clinical practice, and approaches that were taken or recommended to overcome those challenges.

Methods: This scoping review involved comprehensive searches of Medline, CINAHL, and the Cochrane Central Register of Controlled Trials, which yielded 3,133 articles. Following screening, 20 research studies met the inclusion criteria and were included in this review. Data were systematically extracted from the articles using a qualitative content analysis.

Results: Challenges identified were thematically categorized as technical issues, system usability issues, patient lack of comfort/knowledge of technology, incomplete/missing data, lack of patient use of the system, other patient issues, difficulties timing completion with clinical processes, lack of clinic staff involvement/engagement, and lack of clinician comfort/knowledge regarding the use of patient-reported outcome data.

Discussion: The findings of this review highlight challenges that need to be addressed when implementing an electronic symptom reporting system for patients with cancer, and potential strategies for overcoming these challenges. This review may help hospital administrators and clinicians prepare for and improve the implementation of electronic symptom reporting systems into clinical practice, thereby providing evidence to enable their broader use.

原标题、实体名称词、主题标题词、浮动副标题词、关键词标题词、有机体补充概念词、方案补充概念词、罕见病补充概念词、唯一标识符、同义词](自我报告*或患者报告*或自我监测*或自我管理*)。[mp=标题、摘要、原标题、实体词名称、主题标题词、浮动副标题词、关键词标题词、有机体补充概念词、方案补充概念词、罕见病补充概念词、唯一标识符、同义词]

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引用次数: 0

Participation in delivery system reform programs and U.S. acute care hospital integration into behavioral health 参与分娩系统改革计划和美国急性护理医院融入行为健康

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/jhmhp-21-45

Larry R. Hearld, R. Kelly

Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Healthcare Administration and Policy, School of Health Sciences, University of New Haven, West Haven, CT, USA Contributions: (I) Conception and design: LR Hearld; (II) Administrative support: RJ Kelly; (III) Provision of study materials or patients: LR Hearld; (IV) Collection and assembly of data: LR Hearld; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Larry R. Hearld, PhD. Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, SHPB 559, 1720 2 Ave South, Birmingham, Alabama, USA. Email: lhearld@uab.edu.

美国阿拉巴马州伯明翰市阿拉巴马大学卫生专业学院卫生服务管理系；美国康涅狄格州西哈文市纽黑文大学健康科学学院医疗管理与政策系贡献：（I）概念和设计：LR Hearld；（II）行政支持：RJ Kelly；（III）提供研究材料或患者：LR Hearld；（IV）数据收集和汇编：LR Hearld；（V）数据分析和解释：两位作者；（VI）手稿写作：两位作者；（VII）手稿的最终批准：两位作者。通信：Larry R.Hearld，博士。阿拉巴马大学伯明翰分校卫生专业学院卫生服务管理系，SHPB 559，1720 2 Ave South，Birmingham，Alabama，USA电子邮件：lhearld@uab.edu.

引用次数: 0

Artificial intelligence in healthcare-opportunities and challenges 人工智能在医疗保健领域的机遇和挑战

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/JHMHP-21-31

S. Reddy, J. Winter, S. Padmanabhan

The term artificial intelligence (AI) evokes various responses amongst healthcare professionals, researchers and consumers (1). For some, AI could be panacea to all the problems ailing the healthcare sector and yet for others, a fad to be quickly dismissed. The truth is somewhere in between considering the efficacy of machine learning, a subset of AI, has been demonstrated in different areas of medicine with improved diagnosis and treatment being made possible (2). In other instances, AI has been found to useful in drug discovery, infectious disease surveillance and even in aiding efficient healthcare administration. Also, there has been increasing support from governments and the private sector in funding AI in healthcare research and development with a growing number of AI enabled medical software being approved for use in the market (3). However, AI as a new technology, especially so in the realm of medicine, has to be carefully evaluated for its safety and efficacy in achieving its intended outcomes (4). There is requirement for some preparatory work and laying out the ground for integration of AI in routine clinical workflows, while supporting more research and development of AI in healthcare applications. In this special edition, researchers and clinicians from across the world outline the scale of the use of AI in various contexts and key issues to consider in implementing AI in healthcare strategies. Covered in this edition is the ability of AI to enable precision medicine, issues in hospitals using AI for strategic decision making, how AI has been used in the Indian healthcare sector, the role of AI in managing respiratory diseases, the ability of AI to improve the quality of healthcare, why AI and healthcare need each other, and the key data governance challenges involved in implementing AI in healthcare. The collected articles promise not only a good review of AI in healthcare but also a balanced perspective for readers as to what AI can do for healthcare.

人工智能一词在医疗保健专业人员、研究人员和消费者中引起了各种反应（1）。对一些人来说，人工智能可能是解决医疗保健行业所有问题的灵丹妙药，但对其他人来说，这是一种很快被摒弃的时尚。事实介于考虑机器学习（人工智能的一个子集）的功效之间，机器学习已经在医学的不同领域得到了证明，诊断和治疗的改进成为可能（2）。在其他情况下，人工智能被发现在药物发现、传染病监测甚至帮助有效的医疗管理方面都很有用。此外，随着越来越多的人工智能医疗软件被批准在市场上使用，政府和私营部门在资助医疗保健研发中的人工智能方面也得到了越来越多的支持（3）。然而，人工智能作为一项新技术，尤其是在医学领域，必须仔细评估其在实现预期结果方面的安全性和有效性（4）。需要做一些准备工作，为人工智能在常规临床工作流程中的集成奠定基础，同时支持人工智能在医疗保健应用中的更多研发。在本特别版中，来自世界各地的研究人员和临床医生概述了人工智能在各种情况下的使用规模，以及在医疗保健战略中实施人工智能时需要考虑的关键问题。本版涵盖了人工智能实现精准医疗的能力，医院使用人工智能进行战略决策的问题，人工智能在印度医疗保健部门的使用情况，人工智能对呼吸系统疾病的管理作用，人工智能提高医疗保健质量的能力，为什么人工智能和医疗保健相互需要，以及在医疗保健中实施人工智能所涉及的关键数据治理挑战。收集到的文章不仅对人工智能在医疗保健中的作用进行了很好的回顾，而且为读者提供了一个关于人工智能可以为医疗保健做什么的平衡视角。

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引用次数: 1

An examination of the sustainability of the CXO advantage in U.S. hospitals 美国医院CXO优势的可持续性检验

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/jhmhp-21-67

Seongwon Choi, K. Hearld, Alisha Singh, Geoffrey A. Silvera, W. Breen, N. Borkowski

引用次数: 0

Reducing wait times to surgery—an international review 缩短手术等待时间——国际综述

Journal of hospital management and health policy

Pub Date : 2021-01-01 DOI: 10.21037/jhmhp-21-96

Tania Stafinski, F. Nagase, M. Brindle, Jonathan White, Andrea Young, S. Beesoon, S. Cleary, D. Menon

: This study aimed to describe approaches used in Canada and internationally, targeting wait times from the decision to treat to surgery (wait time 2). Access to optimal care at the right place and at the right time remains a top priority for patients, healthcare providers and policymakers. Interviews with key informants from 14 countries and a scoping review were conducted to identify approaches targeting wait times. During interviews, participants were asked about their experiences with different approaches in their jurisdictions. The scoping review adhered to published guidelines and captured both peer-reviewed and grey literature. Results were compiled into tables and synthesized based on a conceptual framework describing the main policy types for improving wait times. The study included 32 interviews, 92 peer-reviewed studies and 242 documents from the grey literature. Information spanned 17 countries across multiple surgical areas. In total, 33 approaches were identified, with the majority [24] targeting the supply-side. Fifteen approaches had consistent or limited but promising evidence supporting their effectiveness. Approaches can impact wait times 2 by targeting demand, supply or both. Successful strategies require the implementation of multiple approaches, collaborations and investments. This study may help organizations plan and implement policies intended to improve timely access to surgical care.

本研究旨在描述在加拿大和国际上使用的方法，针对从决定治疗到手术的等待时间(等待时间2)。在正确的地点和正确的时间获得最佳护理仍然是患者，医疗保健提供者和政策制定者的首要任务。对来自14个国家的关键举报人进行了访谈，并进行了范围审查，以确定针对等待时间的方法。在访谈中，与会者被问及在其管辖范围内采用不同方法的经验。范围审查遵循已发表的指导方针，并收集同行评议和灰色文献。结果被编译成表格，并根据描述改善等待时间的主要策略类型的概念框架进行综合。这项研究包括32次访谈、92项同行评议研究和242份灰色文献。信息涉及17个国家的多个外科领域。总共确定了33种方法，其中大多数针对供应侧。15种方法有一致或有限但有希望的证据支持其有效性。方法可以通过瞄准需求、供应或两者来影响等待时间。成功的战略需要实施多种方法、合作和投资。本研究可能有助于组织计划和实施旨在改善及时获得外科护理的政策。

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引用次数: 1