Nieboer Anna P, Cramm Jane M, Sonneveld Henk M, Roebroeck Marij E, van Staa Anneloes, Strating Mathilde M H
Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
BMC Health Serv Res. 2014 Jan 31;14:47. doi: 10.1186/1472-6963-14-47.
The purpose of this study was to describe the interventions implemented in a quality improvement programme to improve transitional care and evaluate its effectiveness in reducing bottlenecks as perceived by professionals and improving chronically ill adolescents' experiences with care delivery.
This longitudinal study was undertaken with adolescents and professionals who participated in the Dutch 'On Your Own Feet Ahead!' quality improvement programme. This programme followed the Breakthrough Series improvement and implementation strategy.A total of 102/128 (79.7%) professionals from 21 hospital teams filled out a questionnaire at the start of the programme (T0), and 79/123 (64.2%; five respondents had changed jobs) professionals completed the same questionnaire 1 year later (T1). Seventy-two (58.5%) professionals from 21 teams returned questionnaires at both time points. Of 389 and 430 participating adolescents, 36% and 41% returned questionnaires at T0 and T1, respectively. We used descriptive statistics and two-tailed, paired t-tests to investigate improvements in bottlenecks in transitional care (perceived by professionals) and care delivery (perceived by adolescents).
Professionals observed improvement in all bottlenecks at T1 (vs. T0; p < 0.05), especially in the organisation of care, such as the presence of a joint mission between paediatric and adult care, coordination of care, and availability of more resources for joint care services. Within a 1-year period, the transition programme improved some aspects of patients' experiences with care delivery, such as the provision of opportunities for adolescents to visit the clinic alone (p < 0.001) and to decide who should be present during consultations (p < 0.05).
This study demonstrated that transitional care interventions may improve the organisation and coordination of transitional care and better prepare adolescents for the transition to adult care within a 1-year period. By setting specific goals based on experiences with bottlenecks, the breakthrough approach helped to improve transitional care delivery for adolescents with chronic conditions.
本研究旨在描述在一项质量改进计划中实施的干预措施，以改善过渡性护理，并评估其在减少专业人员所感知的瓶颈以及改善慢性病青少年的护理体验方面的有效性。
本纵向研究针对参与荷兰“独立前行！”质量改进计划的青少年和专业人员展开。该计划遵循了突破系列改进与实施策略。来自21个医院团队的102/128名（79.7%）专业人员在计划开始时（T0）填写了问卷，1年后（T1），79/123名（64.2%；5名受访者换了工作）专业人员完成了相同问卷。来自21个团队的72名（58.5%）专业人员在两个时间点都返回了问卷。在389名和430名参与的青少年中，分别有36%和41%在T0和T1返回了问卷。我们使用描述性统计和双尾配对t检验来调查过渡性护理中的瓶颈（专业人员所感知）和护理提供（青少年所感知）方面的改善情况。
专业人员观察到在T1时所有瓶颈均有改善（与T0相比；p<0.05），尤其是在护理组织方面，如儿科和成人护理之间存在联合任务安排、护理协调以及联合护理服务有更多资源可用。在1年时间内，过渡计划改善了患者护理体验的某些方面，例如为青少年提供独自就诊的机会（p<0.001）以及决定会诊时谁应在场（p<0.05）。
本研究表明，过渡性护理干预措施可能改善过渡性护理的组织和协调，并在1年时间内更好地帮助青少年为向成人护理过渡做好准备。通过基于瓶颈体验设定具体目标，突破方法有助于改善慢性病青少年的过渡性护理服务。
