Pearson Mark, Hunt Harriet, Cooper Chris, Shepperd Sasha, Pawson Ray, Anderson Rob
Peninsula Technology Assessment Group (PenTAG), Institute of Health Research, University of Exeter Medical School, Exeter, UK.
Department of Public Health, University of Oxford, Oxford, UK.
Health Soc Care Community. 2015 Nov;23(6):577-93. doi: 10.1111/hsc.12183. Epub 2015 Feb 16.
Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision-making and care co-ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice.
中级护理是旨在整合护理服务并在离家更近的地方提供强化的健康和社会护理服务的多种服务提供模式之一，特别是为了减少对急症护理医院病床的依赖。为了使健康和社会护理从业者、服务经理和专员能够做出明智的决策，了解如何在当地护理系统的背景下实施中级护理的入院避免和早期支持出院部分至关重要。本文报告了2011 - 2012年进行的一项理论驱动（现实主义）综述的结果。193个来源中包含的广泛证据被用于构建中级护理的概念框架。该框架构成了在特定当地背景下设计和提供中级护理服务时应考虑的服务使用者、专业人员和组织层面因素探索的基础。我们的综合研究发现，让服务使用者及其护理人员参与关于护理目标和护理地点的协作决策对于实现中级护理的目标至关重要。服务使用者的这种关键参与依赖于从业者、服务经理和专员意识到地方层面的组织结构对促进或抑制协作决策和护理协调可能产生的影响。通过与服务使用者及其护理网络的所有互动，健康和社会护理专业人员应确定不同护理环境对不同服务使用者的意义。这样做意味着关于最佳护理地点的决策将有更充分的依据，并为服务使用者提供选择。这反过来可能有助于心理和社会稳定以及功能目标的实现。在组织层面，整合工作可以促进中级护理的提供，但整合的组织流程与整合的专业实践之间不存在直接关系。
