Shield Renée, Rosenthal Marsha, Wetle Terrie, Tyler Denise, Clark Melissa, Intrator Orna
Health Services, Policy & Practice, Brown University, Providence, RI, USA.
J Appl Gerontol. 2014 Feb;33(1):75-96. doi: 10.1177/0733464812463432. Epub 2012 Nov 28.
Medical staff (physicians, nurse practitioners, physicians' assistants) involvement in nursing homes (NH) is limited by professional guidelines, government policies, regulations, and reimbursements, creating bureaucratic burden. The conceptual NH Medical Staff Involvement Model, based on our mixed-methods research, applies the Donabedian "structure-process-outcomes" framework to the NH, identifying measures for a coordinated research agenda. Quantitative surveys and qualitative interviews conducted with medical directors, administrators and directors of nursing, other experts, residents and family members and Minimum Data Set, the Online Certification and Reporting System and Medicare Part B claims data related to NH structure, process, and outcomes were analyzed. NH control of medical staff, or structure, affects medical staff involvement in care processes and is associated with better outcomes (e.g., symptom management, appropriate transitions, satisfaction). The model identifies measures clarifying the impact of NH medical staff involvement on care processes and resident outcomes and has strong potential to inform regulatory policies.
医护人员（医生、执业护士、医师助理）参与疗养院事务受到专业指南、政府政策、法规及报销制度的限制，这造成了官僚负担。基于我们的混合方法研究得出的概念性疗养院医护人员参与模型，将多纳贝迪安的“结构-过程-结果”框架应用于疗养院，确定了协调研究议程的措施。我们对医疗主任、管理人员、护理主任、其他专家、居民及其家属进行了定量调查和定性访谈，并分析了与疗养院结构、过程和结果相关的最小数据集、在线认证和报告系统以及医疗保险B部分索赔数据。疗养院对医护人员的管控，即结构，会影响医护人员对护理过程的参与，并与更好的结果相关（如症状管理、适当的转诊、满意度）。该模型确定了一些措施，阐明了疗养院医护人员参与对护理过程和居民结果的影响，并且极有可能为监管政策提供参考。
