Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
BMC Geriatr. 2012 Dec 14;12:75. doi: 10.1186/1471-2318-12-75.
Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH) residents and necessitate transitions between NHs and Emergency Departments (EDs). During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS), and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH - ED transitions.
METHODS/DESIGN: This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT) approach. It uses data from multiple levels (facility, care unit, individual) and sources (healthcare providers, residents, health records, and administrative databases).
Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and researchers to participate equally in developing study goals, design, data collection, analysis and implications of findings. As preliminary and ongoing study findings are developed, their implications for practice and policy in study settings will be discussed by the research team and shared with study site administrators and staff. The study is designed to investigate the complexities of transitions and to enhance the potential for successful and sustained improvement of these transitions.
健康状况的变化，如感染、跌倒和老年综合征等事件引发的变化，在养老院（NH）居民中很常见，需要在 NH 和急诊科（ED）之间进行过渡。在过渡期间，居民经常会经历延迟、不必要、无证据支持、潜在不安全和分散的护理。此外，相当一部分居民及其家庭照顾者在过渡期间报告存在大量未满足的需求。这项研究是一个研究计划的一部分，该计划的总体目标是改善住在 NH 的体弱老年人的护理质量。本研究的目的是从多个角度确定成功的过渡，并确定与过渡成功相关的组织和个人因素，以便为脆弱的老年 NH 居民从急性护理到急性护理的过渡提供改进的护理。具体目标是：1. 从多个角度定义成功和不成功的过渡元素；2. 开发和测试一种实用工具来评估过渡成功；3. 在两个研究地点的一个为期一年的时间内评估一系列离散转移的过渡过程；4. 评估关键实践地点（如 NH、紧急医疗服务（EMS）和 ED）的组织因素对过渡成功的影响；5. 确定与 NH-ED 过渡管理相关的循证管理和质量改进决策的机会。
方法/设计：这是一项混合方法观察性研究，结合了综合知识转化（IKT）方法。它使用来自多个层面（设施、护理单元、个人）和来源（医疗保健提供者、居民、健康记录和行政数据库）的数据。
研究成功的关键是通过使用伙伴关系模式来实施 IKT 方法，在该模式中，OP-TIC 治理结构为团队决策者和研究人员提供了平等参与制定研究目标、设计、数据收集、分析和研究结果的机会。随着初步和正在进行的研究结果的发展，研究团队将讨论这些结果对研究环境中的实践和政策的影响，并与研究地点的管理人员和工作人员分享。该研究旨在调查过渡的复杂性，并提高这些过渡成功和持续改进的潜力。
Zotero 插件