Institute of Primary Care and Health Sciences, University of Keele, Staffordshire, UK.
Health Soc Care Community. 2013 Nov;21(6):598-605. doi: 10.1111/hsc.12042. Epub 2013 May 3.
Good integration of services that aim to reduce avoidable acute hospital bed use by older people requires frontline staff to be aware of service options and access them in a timely manner. In three localities where closer inter-organisational integration was taking place, this research sought patients' perceptions of the care received across and within organisational boundaries. Between February and July 2008, qualitative methods were used to map the care journeys of 18 patients (six from each site). Patient interviews (46) covered care received before, at the time of and following a health crisis. Additional interviews (66) were undertaken with carers and frontline staff. Grounded theory-based approaches showed examples of well-integrated care against a background of underuse of services for preventing health crises and a reliance on 'traditional' referral patterns and services at the time of a health crisis. There was scope to raise both practitioner and patient awareness of alternative care options and to expand the availability and visibility of care 'closer to home' services such as rapid response teams. Concerns voiced by patients centred on the adequacy of arrangements for organising ongoing care, while family members reported being excluded from discussions about care arrangements and the roles they were expected to play. The coordination of care was also affected by communication difficulties between practitioners (particularly across organisational boundaries) and a lack of compatible technologies to facilitate information sharing. Finally, closer organisational integration seemed to have limited impact on care at the patient/practitioner interface. To improve care experienced by patients, organisational integration needs to be coupled with vertical integration within organisations to ensure that strategic goals influence the actions of frontline staff. As they experience the complete care journey, feedback from patients can play an important role in the service redesign agenda.
要将服务进行良好整合，以减少老年人对不必要的急性医院病床的使用，这需要一线工作人员了解服务选项，并及时获取这些服务。在三个更加紧密的组织间整合正在进行的地方，本研究旨在了解患者对跨越和超越组织边界的护理服务的看法。2008 年 2 月至 7 月期间，采用定性方法对 18 名患者（每个地点 6 名）的护理过程进行了映射。患者访谈（46 次）涵盖了在健康危机之前、期间和之后接受的护理。对护理人员和一线工作人员进行了额外的访谈（66 次）。基于扎根理论的方法展示了在预防健康危机方面服务利用不足和依赖“传统”转介模式和服务的背景下，综合护理的示例。有机会提高从业者和患者对替代护理选择的认识，并扩大“离家更近”的护理服务（如快速反应团队）的可用性和可见性。患者关注的问题集中在组织持续护理安排的充分性上，而家庭成员报告说他们被排除在护理安排和他们预期扮演的角色的讨论之外。护理协调还受到从业者之间（特别是跨越组织边界）沟通困难以及缺乏兼容技术以促进信息共享的影响。最后，组织间的紧密整合似乎对患者/从业者界面的护理影响有限。为了提高患者的护理体验，需要将组织整合与组织内的垂直整合相结合，以确保战略目标影响一线工作人员的行动。由于他们体验了完整的护理过程，患者的反馈可以在服务重新设计议程中发挥重要作用。
