Department of Clinical Epidemiology and Biostatistics, McMaster University, Juravinski Cancer Centre, 699 Concession St, Rm 4-203, Hamilton, ON L8V 5C2 Canada.
BMC Palliat Care. 2010 May 10;9:8. doi: 10.1186/1472-684X-9-8.
There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care.
In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors.
The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network.
Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations.
全球对区域姑息治疗网络（PCN）的兴趣日益增加，目的是整合医疗服务，建立在多机构环境中更具成本效益和响应能力的系统。在需要不同专业技能来满足广泛的临终需求的情况下，网络尤其重要。我们提出了一个全面的 PCN 评估框架，重点关注专业间合作的性质和程度、社区准备情况以及以客户为中心的护理。
由于缺乏用于检查 PCN 的总体结构，因此根据卫生系统评估的先前模型、明确的理论以及与 PCN 功能相关的研究文献，制定了一个框架。该研究证据用于证实模型因素的选择。
拟议的框架采用系统方法，考虑系统结构、护理过程和患者结果水平。所代表的每个因素都为网络的描述和评估做出了独立的贡献。
以无缝、具有成本效益的方式实现姑息治疗患者对复杂治疗和社会支持方案的需求，是推动网络综合护理的主要动力。所提出的框架是指导评估的第一步，为制定适当的策略提供信息，以进一步促进 PCN 内的合作，并最终提供满足患者需求和期望的最佳姑息治疗。
