Leone Robert P, Walker Charles A, Curry Linda Cox, Agee Elizabeth J
Online J Issues Nurs. 2012 Apr 3;17(2):7.
Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.
每年接受心力衰竭治疗的患者数量都在增加。在医院接受治疗的心力衰竭患者中，四分之一会在出院后30天内再次入院。有效的出院指导对于防止这些患者再次入院至关重要。共同生产是一种营销理念，即客户是商品或服务交付过程中的合作伙伴。例如，患者和护士可以合作共同制定以患者为中心的健康方案，以改善患者的治疗效果。在本文中，我们回顾了治疗心力衰竭患者的成本、目前减少这些患者再次入院的策略，以及护士的作用和与心力衰竭患者相关的共同生产健康的概念。接下来，我们描述了我们的研究，该研究评估了在两个心力衰竭患者占多数的医院科室中出院过程的共同生产程度，并展示了我们的研究结果，即几乎没有共同生产的证据。我们对研究结果进行了讨论，并阐述了这些结果的临床意义、变革建议以及对未来研究的建议。我们得出结论，标准化的出院计划导致了“一刀切”的思维模式，这种思维模式与最近对以患者为中心的护理的呼吁不一致。我们提出共同生产作为一种以患者为中心的策略，用于定制出院指导并改善心力衰竭患者的健康状况。
