Hung Dorothy, Truong Quan, Yakir Maayan, Nicosia Francesca
Palo Alto Medical Foundation Research Institute, Mountain View, California (Dr Hung and Mss Truong and Yakir); and Division of Geriatrics, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California (Dr Nicosia).
J Nurs Care Qual. 2018 Jul/Sep;33(3):221-228. doi: 10.1097/NCQ.0000000000000294.
This study examined the implementation and hospitalwide scaling of a community-based transitional care program to reduce readmissions among adults 65 years or older. Our analysis was guided by the Care Transitions Framework and was based on semistructured interviews with program implementers to identify intervention successes, barriers, and outcomes beyond reducing readmissions. Such outcomes included the program's critical role in providing a safety net and transition to more advanced care, and redefining intervention success from more patient-centered perspectives.
本研究考察了一项基于社区的过渡性护理项目的实施情况及其在全院范围的推广，该项目旨在减少65岁及以上成年人的再入院率。我们的分析以护理过渡框架为指导，基于对项目实施者的半结构化访谈，以确定干预措施的成功之处、障碍以及除减少再入院率之外的结果。这些结果包括该项目在提供安全网和向更高级护理过渡方面的关键作用，以及从更以患者为中心的角度重新定义干预措施的成功。
