Everink Irma H J, van Haastregt Jolanda C M, Maessen Jose M C, Schols Jos M G A, Kempen Gertrudis I J M
Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
Department of Patient & Integrated Care, Maastricht University Medical Centre, P.O.Box 5800, 6202 AZ, Maastricht, The Netherlands.
BMC Health Serv Res. 2017 Jan 13;17(1):34. doi: 10.1186/s12913-016-1974-5.
An integrated care pathway in geriatric rehabilitation was developed to improve coordination and continuity of care for community-living older adults in the Netherlands, who go through the process of hospital admission, admission to a geriatric rehabilitation facility and discharge back to the home situation. This pathway is a complex intervention and is focused on improving communication, triage and transfers of patients between the hospital, geriatric rehabilitation facility and primary care organisations. A process evaluation was performed to assess the feasibility of this pathway.
The study design incorporated mixed methods. Feasibility was assessed thru if the pathway was implemented according to plan (fidelity and dose delivered), (b) if patients, informal caregivers and professionals were satisfied with the pathway (dose received) and (c) which barriers and facilitators influenced implementation (context). These components were derived from the theoretical framework of Saunders and colleagues. Data were collected using three structured face-to-face interviews with patients, self-administered questionnaires among informal caregivers, and group interviews with professionals. Furthermore, data were collected from the information transfer system in the hospital, patient files of the geriatric rehabilitation facility and minutes of evaluation meetings.
In total, 113 patients, 37 informal caregivers and 19 healthcare professionals participated in this process evaluation. The pathway was considered largely feasible as two components were fully implemented according to plan and two components were largely implemented according to plan. The timing and quality of medical discharge summaries were not sufficiently implemented according to plan and professionals indicated that the triage instrument needed refinement. Healthcare professionals were satisfied with the implementation of the pathway and they indicated that due to improved collaboration, the quality of care provision improved. Although patients and informal caregivers were also satisfied with the care provision in the pathway, they indicated that the care organisations involved should pay more attention towards providing information about their treatment.
This process evaluation showed that patients, informal caregivers and professionals are fairly satisfied with the care provision in the pathway and professionals reported that collaboration improved. Extra attention should be paid to the components in the pathway that were not implemented according to plan.
ISRCTN90000867 Registered 7 April 2016.
荷兰开发了一种老年康复综合护理路径，以改善社区居住的老年人在住院、入住老年康复机构以及出院回家过程中的护理协调和连续性。该路径是一项复杂的干预措施，专注于改善医院、老年康复机构和初级保健组织之间患者的沟通、分诊和转诊。进行了一项过程评估以评估该路径的可行性。
该研究设计采用了混合方法。通过以下方面评估可行性：(a) 该路径是否按计划实施（保真度和实施剂量），(b) 患者、非正式护理人员和专业人员是否对该路径满意（接受剂量），以及 (c) 哪些障碍和促进因素影响了实施（背景）。这些组成部分源自桑德斯及其同事的理论框架。通过与患者进行三次结构化面对面访谈、对非正式护理人员进行自填式问卷调查以及与专业人员进行小组访谈来收集数据。此外，还从医院的信息传输系统、老年康复机构的患者档案以及评估会议记录中收集数据。
共有113名患者、37名非正式护理人员和19名医疗保健专业人员参与了此次过程评估。该路径在很大程度上被认为是可行的，因为有两个组成部分完全按计划实施，另外两个组成部分在很大程度上按计划实施。医疗出院小结的时间安排和质量未充分按计划实施，专业人员表示分诊工具需要完善。医疗保健专业人员对该路径的实施感到满意，他们表示由于协作的改善，护理质量得到了提高。虽然患者和非正式护理人员也对该路径中的护理服务感到满意，但他们表示相关护理组织应更加注重提供有关其治疗的信息。
此次过程评估表明，患者、非正式护理人员和专业人员对该路径中的护理服务相当满意，专业人员报告称协作得到了改善。应特别关注该路径中未按计划实施的组成部分。
ISRCTN90000867 于2016年4月7日注册。
