College of Nursing, East Carolina University, Greenville, NC 27834, USA.
Am J Manag Care. 2012 Jun 1;18(6):e234-7.
To identify barriers encountered by case managers in hospitals, home care agencies, and nursing homes in the transition of the obese patient from the hospital to the community.
Exploratory descriptive design was used. Hospital case managers, nursing home administrators, and Medicare-certified home healthcare agency administrators were surveyed to identify barriers.
Hospital case managers in each licensed acute care hospital, directors of licensed nursing homes, and administrators of the Medicarecertified home healthcare agencies in 1 southern state were surveyed. The survey instrument was designed by the investigators based on variables identified in the literature or encountered within their practice. Instruments consisted of items related to the respondent's experience with barriers such as patient size, degree of patient independence, patient care requirements, staffing levels, and the need for assistive equipment, as well as items used to collect basic demographic information.
Both hospital case managers and nursing home directors reported as major barriers the equipment, the size of the patient, patient independence, and finances. Home care agency directors reported that the presence or absence of a competent caregiver was the major factor in the decision to accept or not accept an obese patient.
Transition of the obese patient presents major challenges. Further exploration is needed to identify the extent of problems and make policy recommendations toward a solution.
确定医院、家庭护理机构和养老院中的个案管理者在将肥胖患者从医院过渡到社区时所遇到的障碍。
采用探索性描述性设计。对医院个案管理者、养老院管理者和医疗保险认证的家庭保健机构管理者进行调查，以确定障碍。
对每个持照的急性护理医院的医院个案管理者、持照养老院的主任和在一个南部州的医疗保险认证的家庭保健机构的管理者进行调查。调查工具是由研究人员根据文献中确定的变量或在实践中遇到的变量设计的。这些工具包括与受访者在患者体型、患者独立性程度、患者护理需求、人员配备水平和辅助设备需求等方面遇到的障碍相关的项目，以及用于收集基本人口统计信息的项目。
医院个案管理者和养老院主任都报告说，设备、患者体型、患者独立性和财务状况是主要障碍。家庭保健机构主任报告说，有能力的护理人员的存在与否是决定是否接受肥胖患者的主要因素。
肥胖患者的过渡带来了重大挑战。需要进一步探索，以确定问题的严重程度，并提出政策建议以寻求解决方案。
