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家庭经历和儿科保健服务的使用与以家庭为中心的查房相关。

Family experiences and pediatric health services use associated with family-centered rounds.

机构信息

Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA.

出版信息

Pediatrics. 2012 Aug;130(2):299-305. doi: 10.1542/peds.2011-2623. Epub 2012 Jul 9.

Abstract

BACKGROUND

Family-centered rounds (FCR) are defined as interdisciplinary bedside teaching rounds with active family participation. The objective of this study was to examine the association of FCR with family experiences and health services use.

METHODS

Prospective study comparing families with a child admitted to general pediatric inpatient services with and without FCR. The presence of FCR elements was assessed before study enrollment. Study data were obtained by an in-person interview, a follow-up phone interview <1 week after discharge, and medical record review. Family outcomes were informed by Consumer Assessment of Healthcare Providers and Systems measures. Health service use outcomes included hour of discharge, number of medications, and overall charges. Primary analyses included χ(2) and multivariate regression. Secondary analyses by using propensity score matching were performed to account for differences on observed variables.

RESULTS

A total of 140 of 203 eligible families were enrolled; 97 completed follow-up surveys (49 on FCR team). Compared with non-FCR, FCR families were more likely to report consistent medical information (P < .001), the option of discussing care plan (P < .001), doctors listening carefully (P < .01), and doctors showing respect (P < .001). No differences were found in number of medications (mean 2.4 vs 2.9, P = .26) or discharge time (mean 3:06 pm versus 2:43 pm, P = .39). No difference was found for hospital charges after adjusting for length of stay outliers.

CONCLUSIONS

FCR are associated with higher parent satisfaction, consistent medical information, and care plan discussion, with no additional burden to health service use. Additional studies should assess FCR under different settings of care.

摘要

背景

以家庭为中心的查房(FCR)被定义为有家庭成员积极参与的跨学科床边教学查房。本研究的目的是探讨 FCR 与家庭体验和卫生服务利用之间的关系。

方法

前瞻性研究比较了接受普通儿科住院服务的儿童的家庭,这些家庭接受了 FCR 和未接受 FCR。在研究入组前评估 FCR 元素的存在。通过面对面访谈、出院后 1 周内的随访电话访谈和病历回顾获得研究数据。家庭结局由医疗保健提供者和系统评估量表(Consumer Assessment of Healthcare Providers and Systems measures)来衡量。卫生服务使用结局包括出院时间、药物种类和总费用。主要分析包括卡方检验和多变量回归。使用倾向评分匹配进行二次分析,以解释观察变量的差异。

结果

共有 203 个符合条件的家庭中,140 个家庭被纳入研究;97 个家庭完成了随访调查(FCR 团队 49 个)。与非 FCR 组相比,FCR 组的家庭更有可能报告一致的医疗信息(P <.001)、讨论护理计划的选择(P <.001)、医生认真倾听(P <.01)和医生表现出尊重(P <.001)。在药物种类(平均 2.4 种与 2.9 种,P =.26)或出院时间(平均下午 3:06 分与下午 2:43 分,P =.39)方面,两组间无差异。在调整了住院时间异常值后,两组间的住院费用也无差异。

结论

FCR 与更高的家长满意度、一致的医疗信息和护理计划讨论相关,且不会增加卫生服务使用的负担。需要进一步研究评估在不同医疗保健环境下 FCR 的效果。

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