Department of Veterans Affairs, Philadelphia, Pennsylvania.
School of Nursing, University of Pennsylvania, Philadelphia.
Gerontologist. 2018 Nov 3;58(6):1177-1187. doi: 10.1093/geront/gnx155.
The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption.
Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data.
We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities.
These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes.
大量文献记录显示，虚弱的养老院居民需要减少繁琐且昂贵的住院治疗。Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care（OPTIMISTIC）项目通过多方面的协作护理模式实现了这一目标。我们进行了一项以实施为重点的项目评估，以描述利益相关者对以下方面的看法：（a）干预措施中最有效和最无效的部分；（b）实施障碍；（c）促进其采用的项目特征。
19 家养老院参与了 OPTIMISTIC 项目。我们对 63 名利益相关者进行了半结构化的定性访谈，其中包括 23 名养老院工作人员和领导、4 名初级保健提供者、10 名家庭成员和 26 名 OPTIMISTIC 临床工作人员。我们使用定向内容分析来分析数据。
我们发现，深入的预先护理计划（ACP）讨论有助于减少住院治疗和改善护理，这一点得到了普遍认可。同样，所有利益相关者群体都强调，养老院能够获得经过特别培训的、项目注册护士（RN）和执业护士（NP），他们有时间专注于 ACP、全面的居民评估和工作人员教育，这对于确定居民的护理目标特别有价值。实施过程中的挑战包括设施工作人员培训不足和对改变实践的抵制。此外，该计划有时未能清晰传达其目标和活动，导致设施对 OPTIMISTIC 临床工作人员在设施中的角色不确定。
这些发现对于 OPTIMISTIC 护理模式的传播工作非常重要，并且可能适用于养老院的其他创新。
