关系、专业知识、激励措施与治理：支持养老院居民获得医疗保健。一项来自英国的访谈研究。
Relationships, expertise, incentives, and governance: supporting care home residents' access to health care. An interview study from England.
作者信息
Goodman Claire, Davies Sue L, Gordon Adam L, Meyer Julienne, Dening Tom, Gladman John R F, Iliffe Steve, Zubair Maria, Bowman Clive, Victor Christina, Martin Finbarr C
机构信息
Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK.
Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK.
出版信息
J Am Med Dir Assoc. 2015 May 1;16(5):427-32. doi: 10.1016/j.jamda.2015.01.072. Epub 2015 Feb 14.
OBJECTIVES
To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes.
METHODS
Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health.
RESULTS
Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive.
CONCLUSION
The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations.
目标
探讨英格兰的医疗服务委托方、监管机构、服务提供方以及养老院居民认为，不同服务提供模式中支持向独立养老院提供国民医疗服务（NHS）的关键机制或组成部分是什么。
方法
对养老院医疗服务委托、提供和监管以及养老院居民方面有直接经验的人员进行有目的抽样的定性、半结构化访谈。通过对之前关于养老院居民获得医疗服务的个人经历和优先事项的访谈进行二次分析，增强访谈数据。分析以现实主义评价的假设为框架，并采用持续比较法来确定实现向养老院提供高质量医疗服务和居民健康所需条件的关键主题。
结果
参与者确定了三种相互重叠的提供NHS服务的方法，他们认为这些方法有助于养老院中的老年人获得医疗服务：（1）投资于关系性工作，促进来访的NHS工作人员与养老院工作人员之间的连续性和共同学习；（2）提供适合老年人的临床服务；（3）治理安排，利用合同和财务激励措施来明确养老院应获得的最低服务。
结论
这三种方法以及它们的典型运作方式，丰富地呈现了利益相关者的观点以及关于服务提供模式应如何与养老院合作的潜在假设。研究结果为如何审视养老院有效运作的证据提供了参考，以确定不同方法或这些方法的特定关键要素如何在不同情况下为居民以及相关的健康和社会护理组织带来不同的健康相关结果。
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