Lafortune Claire, Elliott Jacobi, Egan Mary Y, Stolee Paul
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 75 Laurier Ave East, Ottawa, ON, K1N 6N5, Canada.
Patient. 2017 Apr;10(2):215-224. doi: 10.1007/s40271-016-0193-9.
While standardized health assessments capture valuable information on patients' demographic and diagnostic characteristics, health conditions, and physical and mental functioning, they may not capture information of most relevance to individual patients and their families. Given that patients and their informal caregivers are the experts on that patient's unique context, it is important to ensure they are able to convey all relevant personal information to formal healthcare providers so that high-quality, patient-centered care may be delivered. This study aims to identify information that older patients and families consider important but that might not be included in standardized assessments.
Transcripts were analyzed from 29 interviews relating to eight patients with hip fractures from three sites (large urban, smaller urban, rural) in two provinces in Canada. These interviews were conducted as part of a larger ethnographic study. Each transcript was analyzed by two researchers using content analysis. Results were reviewed in two focus group interviews with older adults and family caregivers. Identified themes were compared with items from two standardized assessments used in healthcare settings.
Three broad themes emerged from the qualitative analysis that were not covered in the standardized assessments: informal caregiver and family considerations, insider healthcare knowledge, and patients' healthcare attitudes and experiences. The importance of these themes was confirmed through focus group interviews. Focus group participants also emphasized the importance of conducting assessments in a patient-centered way and the importance of open-ended questions.
A less structured interview approach may yield information that would otherwise be missed in standardized assessments. Combining both sources could yield better-informed healthcare planning and quality-improvement efforts.
虽然标准化健康评估能获取有关患者人口统计学和诊断特征、健康状况以及身心功能的有价值信息，但它们可能无法获取与个体患者及其家庭最相关的信息。鉴于患者及其非正式照护者是该患者独特背景的专家，确保他们能够向正规医疗服务提供者传达所有相关个人信息，以便提供高质量的以患者为中心的护理非常重要。本研究旨在识别老年患者及其家庭认为重要但可能未包含在标准化评估中的信息。
对来自加拿大两个省份三个地点（大城市、小城市、农村）的八名髋部骨折患者的29次访谈记录进行了分析。这些访谈是一项更大的人种学研究的一部分。两名研究人员使用内容分析法对每份记录进行了分析。在与老年人和家庭照护者的两次焦点小组访谈中对结果进行了审查。将识别出的主题与医疗环境中使用的两项标准化评估中的项目进行了比较。
定性分析得出了三个广泛的主题，这些主题在标准化评估中未涉及：非正式照护者和家庭考量、内部医疗知识以及患者的医疗态度和经历。这些主题的重要性在焦点小组访谈中得到了证实。焦点小组参与者还强调了以患者为中心进行评估的重要性以及开放式问题的重要性。
一种结构较少的访谈方法可能会产生标准化评估中原本会遗漏的信息。将这两种来源结合起来可以产生更明智的医疗规划和质量改进措施。
