Fathi Roya, Sheehan Orla C, Garrigues Sarah K, Saliba Debra, Leff Bruce, Ritchie Christine S
Division of Geriatrics, University of California, San Francisco, San Francisco, CA; VA Quality Scholars Fellowship Program, San Francisco VA Medical Center, San Francisco, CA.
Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD.
J Am Med Dir Assoc. 2016 Aug 1;17(8):725-729.e10. doi: 10.1016/j.jamda.2016.03.018. Epub 2016 May 20.
The unique needs of homebound adults receiving home-based medical care (HBMC) (ie, home-based primary care and home-based palliative care services) are ideally provided by interdisciplinary care teams (IDTs) that provide coordinated care. The composition of team members from an array of organizations and the unique dimension of providing care in the home present specific challenges to timely access and communication of patient care information. The objective of this work was to develop a conceptual framework and corresponding quality indicators (QIs) that assess how IDT members for HBMC practices access and communicate key patient information with each other.
A systematic review of peer-reviewed and gray literature was performed to inform a framework for care coordination in the home and the development of candidate QIs to assess processes by which all IDT members optimally access and use patient information. A technical expert panel (TEP) participated in a modified Delphi process to assess the validity and feasibility of each QI and to identify which would be most suitable for testing in the field.
Thematic analysis of literature revealed 4 process themes for how HBMC practices might engage in high-quality care coordination: using electronic medical records, conducting interdisciplinary team meetings, sharing standardized patient assessments, and communicating via secure e-messaging. Based on these themes, 9 candidate QIs were developed to reflect these processes. Three candidate QIs were assessed by the TEP as valid and feasible to measure in an HBMC practice setting. These indicators focused on use of IDT meetings, standardized patient assessments, and secure e-messaging.
Translating the complex issue of care coordination into QIs will improve care delivered to vulnerable home-limited adults who receive HBMC. Guided by the literature, we developed a framework to reflect optimal care coordination in the home setting and identified 3 candidate QIs to field-test in HBMC practices.
接受居家医疗护理（HBMC）（即居家初级护理和居家姑息治疗服务）的行动不便成年人的独特需求，理想情况下应由提供协调护理的跨学科护理团队（IDT）来满足。来自一系列组织的团队成员构成以及在家庭中提供护理的独特层面，给患者护理信息的及时获取和沟通带来了特定挑战。这项工作的目的是制定一个概念框架和相应的质量指标（QIs），以评估HBMC实践中的IDT成员如何相互获取和沟通关键患者信息。
对同行评审文献和灰色文献进行系统综述，以为居家护理协调框架及评估所有IDT成员最佳获取和使用患者信息流程的候选QIs的制定提供参考。一个技术专家小组（TEP）参与了改良的德尔菲过程，以评估每个QIs的有效性和可行性，并确定哪些最适合在实地进行测试。
文献的主题分析揭示了HBMC实践可能如何进行高质量护理协调的4个过程主题：使用电子病历、召开跨学科团队会议、共享标准化患者评估以及通过安全电子信息进行沟通。基于这些主题，制定了9个候选QIs以反映这些过程。TEP评估了3个候选QIs在HBMC实践环境中进行测量是有效且可行的。这些指标侧重于IDT会议的使用、标准化患者评估和安全电子信息。
将护理协调这一复杂问题转化为QIs将改善为接受HBMC服务的行动不便的弱势成年人提供的护理。在文献的指导下，我们制定了一个框架来反映居家环境中的最佳护理协调，并确定了3个候选QIs在HBMC实践中进行实地测试。
