背景:已经制定了一些针对低价值护理的举措(即,浪费)在决策中取得了不同的成功。因此,决策是一个复杂的过程,上下文对低价值护理决策的影响是有限的。因此,需要更详细地了解居民的决策,以减少未来的低价值护理。这项研究探讨了居民经历的哪些因素会影响他们关于低价值护理的决策。
方法:我们采用名义分组技术(NGT)选择四个低价值护理小插曲。在这些小插曲的提示下,我们对居民进行了个别采访。我们使用归纳-演绎方法对定性数据进行了主题分析,以布朗芬布伦纳的社会生态框架为指导。这一框架在社会政治方面为“背景”提供了指导,环境,组织,人际关系,和个人水平。
结果:2022年,我们采访了荷兰一所大学医学中心的19名居民。我们确定了33个影响居民决策的环境因素,鼓励或不鼓励低价值护理。环境因素存在于以下层次,具有相应的类别:(1)环境和社会政治:社会,专业医学协会,和治理;(2)组织:设施特征,社会基础设施,和工作基础设施;(3)人际关系:住院病人,住院医师监督,和居民-其他人;和(4)个人:个人属性和工作结构。
结论:本文描述了影响居民低价值护理决策的33个环境因素。居民尤其受到与患者和主管互动相关的因素的影响。此外,组织因素和更广泛的环境设定了居民做出决策的边际。虽然承认可能有必要采取针对所有环境因素的多(面)干预方法来阻止低价值护理的提供,改善居民-患者动态中的沟通技巧,以识别和解释低价值护理似乎是居民可以自己施加影响的一个特殊兴趣点。
BACKGROUND: Several initiatives have been developed to target low-value care (ie, waste) in decision-making with varying success. As such, decision-making is a complex process and
context\'s influence on decisions concerning low-value care is limitedly explored. Hence, a more detailed understanding of residents\' decision-making is needed to reduce future low-value care. This study explores which contextual factors residents experience to influence their decision-making concerning low-value care.
METHODS: We employed nominal group technique (NGT) to select four low-value care vignettes. Prompted by these vignettes, we conducted individual interviews with residents. We analyzed the qualitative data thematically using an inductive-deductive approach, guided by Bronfenbrenner\'s social-ecological framework. This framework provided guidance to \"
context\" in terms of sociopolitical, environmental, organizational, interpersonal, and individual levels.
RESULTS: In 2022, we interviewed 19 residents from a Dutch university medical center. We identified 33 contextual factors influencing residents\' decision-making, either encouraging or discouraging low-value care. The contextual factors resided in the following levels with corresponding categories: (1) environmental and sociopolitical: society, professional medical association, and governance; (2) organizational: facility characteristics, social infrastructure, and work infrastructure; (3) interpersonal: resident-patient, resident-supervising physician, and resident-others; and (4) individual: personal attributes and work structure.
CONCLUSIONS: This paper describes 33 contextual factors influencing residents\' decision-making concerning low-value care. Residents are particularly influenced by factors related to interactions with patients and supervisors. Furthermore, organizational factors and the broader environment set margins within which residents make decisions. While acknowledging that a multi(faceted)-intervention approach targeting all contextual factors to discourage low-value care delivery may be warranted, improving communication skills in the resident-patient dynamics to recognize and explain low-value care seems a particular point of interest over which residents can exercise an influence themselves.