Purdue University, West Lafayette, IN.
Purdue University, West Lafayette, IN.
J Am Med Dir Assoc. 2017 Jun 1;18(6):539-543. doi: 10.1016/j.jamda.2017.03.001. Epub 2017 Apr 18.
The objective of this study was to evaluate the feasibility and impact of implementing a person-centered medical care model for post-acute care residents within a skilled nursing facility (SNF).
A mixed-method (qualitative and quantitative) pilot evaluation.
An 89-bed SNF located within a large midwestern city.
Forty SNF post-acute patients admitted to the facility during a 6-month period were enrolled in the pilot evaluation. The patients were 75% women, 57% African American, and had an average age of 73. To meet inclusion criteria, patients must have been admitted to the facility for rehabilitation with a plan for community discharge, and be cognitively able to consent as indicated by a cognitive screening tool or assent to participation with family member consent.
The person-centered medical care model included (1) biweekly interdisciplinary care plan meetings, scheduled at a time of patients' preference and held in the patient's room; (2) patient selection of health-related goals that guide team discussions; (3) use of lay-language that facilitated patient understanding; (4) team accountability to the patient for patient care preferences; and (5) monthly care-team meetings to exchange feedback regarding the team's performance and the model.
Evaluation data included admission and discharge Patient Activation Measure surveys; admission and discharge Care of Chronic Conditions surveys; admission and biweekly modified Castle Satisfaction Surveys; admission and discharge Patient and Caregiver Engagement surveys; and semistructured interviews with a sample of staff, family members, and patients.
A significant (P < .01) improvement was noted between admission and discharge on both the Care for Chronic Conditions and the Patient Activation Measure surveys. Patient satisfaction surveys trended toward higher ratings over time on most questions, with significant improvement in 2 questions addressing satisfaction with their medical provider. Interviews revealed a perception that the model encouraged an environment of respect and honesty in patient communications, and an overall positive experience. The challenges of scheduling and time were noted by respondents.
Implementation of person-centered medical care within an SNF was feasible, yet required changing care processes to better address individual goals and facilitate communication among patients, providers, and SNF staff. Overall pilot results indicated that patients and staff members viewed the person-centered care experience positively. Further research is needed to examine long-term effects of the model on resident outcomes.
本研究旨在评估在一家熟练护理机构（SNF）中为急性后护理居民实施以患者为中心的医疗护理模式的可行性和影响。
混合方法（定性和定量）试点评估。
位于中西部大城市的一家 89 床 SNF。
在 6 个月期间入住该设施的 40 名 SNF 急性后患者参加了试点评估。患者中 75%为女性，57%为非裔美国人，平均年龄为 73 岁。为符合纳入标准，患者必须因康复而入住该设施，并计划社区出院，且认知能力必须通过认知筛查工具表明能够同意，或在有家庭成员同意的情况下表示同意参与。
以患者为中心的医疗护理模式包括：（1）两周一次的跨学科护理计划会议，按患者偏好的时间安排，并在患者的房间内举行；（2）患者选择指导团队讨论的与健康相关的目标；（3）使用便于患者理解的通俗语言；（4）团队对患者的护理偏好负责；（5）每月护理团队会议，交流团队绩效和模型方面的反馈。
评估数据包括入院和出院时的患者激活测量调查；入院和出院时的慢性疾病护理调查；入院和每两周一次的改良城堡满意度调查；入院和出院时的患者和护理人员参与度调查；以及对员工、家庭成员和患者样本的半结构化访谈。
在慢性疾病护理和患者激活测量调查中，入院和出院时均显著（P < 0.01）改善。患者满意度调查显示，随着时间的推移，大多数问题的评分呈上升趋势，其中 2 个问题关于对医疗服务提供者的满意度有显著改善。访谈显示，该模式鼓励在医患沟通中营造尊重和诚实的环境，整体体验积极。受访者还指出了安排时间的挑战。
在 SNF 中实施以患者为中心的医疗护理是可行的，但需要改变护理流程，以更好地满足个人目标，并促进患者、提供者和 SNF 员工之间的沟通。试点总体结果表明，患者和工作人员对以患者为中心的护理体验持积极态度。需要进一步研究以检查该模式对居民结果的长期影响。
