Quintuple Aim

  • 文章类型: Journal Article
    五重目标旨在通过解决健康的社会决定因素(SDOH)来改善医疗保健,占医疗结果的70-80%。与SDOH相关的问题传统上是通过转介给社会工作者和社区组织(CBO)来解决的,但是这些途径在将患者与资源联系起来方面的成功有限。鉴于到2050年,健康不平等预计将使美国损失近3000亿美元,新的人工智能(AI)技术可能会帮助提供商解决SDOH问题。在这篇评论中,我们介绍了我们使用ChatGPT为费城原型患者获得SDOH管理建议的经验,PA.ChatGPT确定了相关的SDOH资源,并为当地组织提供了联系信息。未来的探索可以改进AI提示,并将AI集成到电子医疗记录中,以便在预约期间为医疗保健提供者提供实时的SDOH建议。
    The Quintuple Aim seeks to improve healthcare by addressing social determinants of health (SDOHs), which are responsible for 70-80% of medical outcomes. SDOH-related concerns have traditionally been addressed through referrals to social workers and community-based organizations (CBOs), but these pathways have had limited success in connecting patients with resources. Given that health inequity is expected to cost the United States nearly USD 300 billion by 2050, new artificial intelligence (AI) technology may aid providers in addressing SDOH. In this commentary, we present our experience with using ChatGPT to obtain SDOH management recommendations for archetypal patients in Philadelphia, PA. ChatGPT identified relevant SDOH resources and provided contact information for local organizations. Future exploration could improve AI prompts and integrate AI into electronic medical records to provide healthcare providers with real-time SDOH recommendations during appointments.
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  • 文章类型: Journal Article
    有效的术前过程的关键要素包括:历史记录,风险评估,共同决策,有效的跨学科交流,术前优化可修改的条件,纵向护理协调,对人口健康目标的贡献,并收集结果驱动的指标。围手术期医学原则可由各种规模和人口统计学的卫生系统应用,以提高质量和安全性。
    Key elements of an effective preoperative process include the following: history-taking, risk assessment, shared decision making, effective interdisciplinary communication, preoperative optimization of modifiable conditions, longitudinal care coordination, contribution to population health aims, and collection of outcomes-driven metrics. Perioperative medicine tenets can be applied by health systems of all sizes and demographics to improve quality and safety.
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  • 文章类型: Journal Article
    随着数字医疗服务在丹麦背景下的使用和用途不断扩大,嵌入其中的功能也在不断扩展,构成公民获得医疗保健服务和个人健康数据的权利。在丹麦,数字医疗不平等的影响在很大程度上仍未被探索,随着行业数字化转型的推进,密切关注这一方面至关重要。根据《丹麦卫生法》(2019年),丹麦的医疗保健系统需要确保容易和平等地获得医疗保健,高质量的治疗,连贯的患者路径,自由选择,易于获取信息,透明度,每个公民的等待时间都很短。这些是受医疗保健数字化影响的重点法律要求。因此,基于来自高度数字化国家的见解,在这种情况下,丹麦,本文旨在引发关于数字医疗不平等的讨论,应对当前的挑战,并通过阐述概念来考虑未来的方向,伦理,证据知情,以及与数字医疗不平等相关的方法学问题。具体来说,本文讨论了为什么丹麦背景下数字医疗保健的不平等需要更多关注,健康公平如何嵌入丹麦立法,以及如何从道德角度来对待它。中心焦点围绕赋权的基本原则,解放,和公平,强调医疗保健的数字化应积极努力防止和避免医疗保健不平等的长期存在。本文最后讨论了确保更可持续发展的未来方向,健壮,公平的数字医疗系统。
    As digital healthcare services are expanding in use and purpose in a Danish context so are the functionalities embedded in these, constituting citizens\' access to healthcare services and personal health data. In Denmark, the impact of inequalities in digital healthcare remains largely unexplored, making it crucial to pay close attention to this aspect as the digital transformation of the sector progresses. According to the Danish Health Act (2019), the Danish healthcare system is required to ensure easy and equal access to healthcare, high-quality treatment, coherent patient pathways, freedom of choice, easy access to information, transparency, and short waiting times for every citizen. These are focal law-based requirements influenced by the digitalisation of healthcare. Hence, based on insights from a highly digitalised country, in this case, Denmark, this paper aims to initiate a discussion on inequities in digital healthcare, address current challenges, and consider future directions by elaborating on conceptual, ethical, evidence-informed, and methodological issues linked to inequities in digital healthcare. Specifically, this paper discusses why inequities in digital healthcare in a Danish context need increased attention, how health equity is embedded in Danish legislation and how it can be approached from an ethical perspective. The central focus revolves around the essential principles of empowerment, emancipation, and equity, which are being highlighted to emphasise that the digitalisation of healthcare should actively work towards preventing and avoiding the perpetuation of healthcare inequalities. The paper concludes by discussing future directions for ensuring a more sustainable, robust, and equitable digital healthcare system.
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  • 文章类型: Journal Article
    未经评估:患者满意度和经验是衡量整体护理质量的重要指标。2017年,全国社区卫生中心协会(NACHC)发起了一项倡议,以促进联邦合格卫生中心(FQHC)内组织系统的变革,目的是改善价值驱动型护理。
    未经评估:NACHC与八个健康中心合作,四个在佐治亚州,四个在爱荷华州,以及他们的州初级保健协会,应用值转换框架(VTF)。该框架将基于证据的实践提取为目标驱动的系统变更的实践知识。它提供了可操作的步骤,以帮助医疗中心实现改善健康结果的价值驱动目标,改善患者和工作人员的体验,降低成本,和提高公平性(称为五重目标)。本文报告了应用VTF系统改变以提高结直肠癌筛查率的患者和工作人员的经验。
    UNASSIGNED:患者和工作人员的满意度和经验仍然很高,即使在本项目实施了广泛的组织变革之后。实施组织变革的系统方法,通过VTF的应用,没有负面影响患者或工作人员的经验。
    UNASSIGNED:患者和工作人员的满意度和经验是积极的,尽管应用了VTF和全系统的组织变革。这些经验结果伴随着癌症筛查率的提高,从完整的项目结果中观察到。研究人员感到鼓舞的是,使用VTF进行系统更改的应用可能会导致实现五重目标目标,而不会破坏患者和工作人员的体验。调查人员建议继续探索这种转变方法。
    UNASSIGNED: Patient satisfaction and experience are important measures of overall quality of care. In 2017, the National Association of Community Health Centers (NACHC) launched an initiative to facilitate changes across organizational systems within Federally Qualified Health Centers (FQHCs) with the goal of improving value-driven care.
    UNASSIGNED: NACHC worked with eight health centers, four in Georgia and four in Iowa, along with their state Primary Care Associations, to apply the Value Transformation Framework (VTF). This framework distills evidence-based practices into practical knowledge for goal-driven systems change. It provides actionable steps to help health centers reach value-driven goals of improved health outcomes, improved patient and staff experience, reduced costs, and improved equity (referred to as the Quintuple Aim goals). This paper reports on the patient and staff experience when applying VTF systems changes to improve colorectal cancer screening rates.
    UNASSIGNED: Patient and staff satisfaction and experience remained highly rated even after extensive organizational changes were implemented as part of this project. Implementation of a systems-approach to organizational change, through application of the VTF, did not negatively impact patient or staff experiences.
    UNASSIGNED: Patient and staff satisfaction and experience were positive despite the application of the VTF and systems-wide organizational changes. These experience results were alongside improved cancer screening rates, as observed from full project results. Investigators are encouraged that the application of systems change using the VTF may result in the achievement of Quintuple Aim goals without disrupting the experience of patients and staff. Investigators recommend continued exploration of this transformation approach.
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