Health Services Research Unit and Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK.
Disabil Rehabil. 2013 Mar;35(5):388-96. doi: 10.3109/09638288.2012.694960. Epub 2012 Jun 22.
Clinicians' actions impact the patient care process and pathway. This study identified clinicians' actions associated with successful care processes in one community healthcare setting, children's occupational therapy.
A secondary analysis in a form of a quantitative content analysis was conducted of 47 interview transcripts, describing outcomes and therapists' (n = 25) self-reported actions in 25 "successful" and 22 "unsuccessful" care processes. The successful processes were those with positive outcomes (clear and coherent process with easy discharge; achieved patient goals and positive patient-clinician relationships). The transcripts were coded for presence of therapists' actions and non-actions using content analysis; and actions associated with success of the process were identified by Pearson Chi-square test.
In total 207 actions were identified. These clustered around six areas: assessment, setting goals and planning actions, treatment, review, discharging, and managing processes and relationships. The key actions associated with successful processes were: gather perspectives from others at assessment (χ(2) = 6.65, p < 0.01); identify therapy goals (13.16, p < 0.01); agree/communicate plans, roles and responsibilities (9.10, p < 0.01); involve the child and parents in treatment (6.36, p = 0.01); adapt physical environment (6.01, p = 0.01) and make comparisons between the baseline, current and target levels when reviewing progress (6.36, p = 0.01).
The actions identified are congruent with literatures about patient involvement and goal achievement. Specific hypotheses about the mechanisms by which the identified actions may relate to care process are presented.
临床医生的行动会影响患者的护理过程和路径。本研究旨在确定在一个社区医疗保健环境（儿童职业治疗）中与成功护理过程相关的临床医生的行动。
对 47 份访谈记录进行二次分析，采用定量内容分析形式，描述 25 个“成功”和 22 个“不成功”护理过程的结果和治疗师（n=25）的自我报告行动。成功的过程是指那些具有积极结果的过程（清晰连贯的过程，易于出院；实现患者目标和积极的医患关系）。使用内容分析对治疗师的行动和非行动进行编码；并通过皮尔逊卡方检验确定与过程成功相关的行动。
共确定了 207 项行动。这些行动集中在六个领域：评估、设定目标和计划行动、治疗、审查、出院以及管理过程和关系。与成功过程相关的关键行动包括：在评估时从他人那里收集观点（χ²=6.65，p<0.01）；确定治疗目标（13.16，p<0.01）；就计划、角色和责任达成一致/沟通（9.10，p<0.01）；让孩子和家长参与治疗（6.36，p=0.01）；适应物理环境（6.01，p=0.01）并在审查进展时比较基线、当前和目标水平（6.36，p=0.01）。
确定的行动与关于患者参与和目标实现的文献一致。提出了关于所确定的行动如何与护理过程相关的具体假设。
