Lovink Marleen Hermien, Persoon Anke, van Vught Anneke J A H, Schoonhoven Lisette, Koopmans Raymond T C M, Laurant Miranda G H
Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.
Department of Primary and Community Care, Radboud university Medical Center, Radboud Institute for Health Sciences, the Netherlands.
BMJ Open. 2017 Jun 8;7(6):e015134. doi: 10.1136/bmjopen-2016-015134.
In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare.
This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory.
The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government.
在发达国家，养老院中用执业护士、医师助理和护士替代医生（医生替代）的情况时有发生，这是为应对人口老龄化和人员短缺带来的挑战，同时也是为了保证养老院护理质量。然而，养老院中医生替代的模式存在很大差异，而且其如何能最佳地提升医疗质量尚不清楚。本研究旨在深入了解医生替代是如何建模的，以及它是否有助于提高医疗感知质量。其次，本研究旨在深入了解医生替代中有助于医疗质量的要素。
本研究将采用基于现实主义评价原则的多案例研究设计。现实主义评价基于四个用于解释和理解干预措施的概念：背景、机制、结果以及背景 - 机制 - 结果配置。将采取以下步骤：（1）构建理论，（2）进行七个案例研究，（3）在每个案例后分析结果模式并在最后进行跨案例分析，以及（4）修订初始理论。
荷兰阿纳姆奈梅亨地区的研究伦理委员会得出结论，本研究不属于荷兰《涉及人类受试者的医学研究法案》（WMO）的范围（注册号2015/1914）。在研究开始前，将以口头和书面形式通知养老院组织的董事会，并征求其知情同意。此外，将以口头和书面形式通知所有参与者，并征求其知情同意。研究结果将通过在同行评审期刊上发表、在国际和全国会议上报告、向全国专业协会以及国家政府中的政策合作伙伴进行传播。
