Innovando en la toma de decisiones compartida con pacientes hospitalizados: descripción y evaluación de una herramienta de registro de nivel de intensidad terapéutica / Improving shared decision-making for hospital patients: description and evaluation of a treatment intensity assessment tool

Fundamento y objetivo. La toma de decisiones compartida entre pacientes y profesionales es un elemento clave de la atención centrada en la persona y tiene como objetivo facilitar la adecuada armonización entre los valores y preferencias de los pacientes, los objetivos asistenciales propuestos y la intensidad de las intervenciones realizadas. Pero tan importante como velar por la calidad de este proceso colaborativo es poder disponer de sistemas que permitan registrarlo de forma fiable y sencilla, con el objetivo de preservar la coherencia en las decisiones durante el proceso asistencial. El presente estudio describe un sistema de registro de nivel de intensidad terapéutica (NIT) diseñada para tal fin y evalúa los resultados de su implementación. Material y método. Se comparan los resultados pre-implementación y post-implementación en 2 cohortes de pacientes registrados durante un período de un mes, respectivamente. Resultados. El 6,1% de los pacientes del grupo pre-implementación (n = 673) tienen algún registro de nivel asistencial, frente al 31,6% del grupo post-implementación (n = 832) (p < 0,01), existiendo diferencias entre servicios. La mortalidad intrahospitalaria de ambas cohortes es del 1,9%; el 93,75% de los pacientes del grupo post-implementación que fallecieron tenían registro de NIT. Conclusiones. La disponibilidad de una herramienta hospitalaria específica parece incentivar el proceso de toma de decisiones compartidas entre pacientes y profesionales —multiplicando por más de 5 veces el registro de NIT—, facilita la continuidad asistencial entre equipos y permite monitorizar la personalización de las intervenciones. Serán necesarios más estudios para seguir avanzando en la toma de decisiones compartida con los pacientes hospitalizados (AU)

Background and aim. Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. Material and methods. The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. Results. Some record of care was registered in 6.1% of patients in the pre-implementation group (n = 673) compared to 31.6% of patients in the post-implementation group (n = 832) (P < .01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. Conclusions. In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals —multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients (AU)

[Improving shared decision-making for hospital patients: Description and evaluation of a treatment intensity assessment tool]. / Innovando en la toma de decisiones compartida con pacientes hospitalizados: descripción y evaluación de una herramienta de registro de nivel de intensidad terapéutica.

BACKGROUND AND AIM: Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. MATERIAL AND METHODS: The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. RESULTS: Some record of care was registered in 6.1% of patients in the pre-implementation group (n=673) compared to 31.6% of patients in the post-implementation group (n=832) (P<.01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. CONCLUSIONS: In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals -multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients.

Which osteotomy for a valgus knee?

A valgus knee is a disabling condition that can affect patients of all ages. Antivalgus osteotomy of the knee is the treatment of choice to correct the valgus, to eliminate pain in the young or middle age patient, and to avoid or delay a total knee replacement. A distal femoral lateral opening wedge procedure appears to be one of the choices for medium or large corrections and is particularly easy and precise if compared to the medial femoral closing wedge osteotomy. However, if the deformity is minimal, a tibial medial closing wedge osteotomy can be done with a faster healing and a short recovery time.

Osteotomies: the surgical treatment of the valgus knee.

Lateral compartment arthrosis from congenital valgus or the result of previous lateral meniscectomy can be a disabling condition. Realignment osteotomy, which may avoid or delay the need for a total knee replacement, is appropriate for young or middle-aged patients suffering from a painful valgus knee. Medium or large corrections can be managed with distal femoral lateral opening wedge osteotomy while minimal deformities are best treated with medial closing wedge tibial osteotomy.