Busetto Loraine, Luijkx Katrien, Calciolari Stefano, González Ortiz Laura Guadalupe, Vrijhoef Hubertus Johannes Maria
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, the Netherlands.
PLoS One. 2017 Dec 21;12(12):e0187468. doi: 10.1371/journal.pone.0187468. eCollection 2017.
Integrated care interventions introduced in response to the increased demand for long-term care entail profound changes to the health workforce. This exploratory study aims to provide an overview of the workforce changes implemented as part of integrated chronic care interventions.
An interactive and emergent research design was used consisting of a literature review, qualitative expert questionnaires and case reports. We defined integrated care as interventions targeting at least two of the six Chronic Care Model components. Workforce changes were defined as those changes experienced by clinical and non-clinical staff responsible for public and individual health intervention.
Seven workforce changes were identified: (1) nurse involvement, (2) multidisciplinary staff, (3) multidisciplinary protocols/pathways, (4) provider training, (5) case manager/care coordinator, (6) team meetings, and (7) new positions. Most interventions included more than one of these workforce changes.
The results of this study provide detailed insights into the current implementation of workforce changes in integrated care interventions and thereby pave the way for further investigations into the relative effectiveness of different workforce changes within the scope of complex interventions. Advancing knowledge in this area is essential for fostering health systems' capacity to cope with the challenges related to the current demographic and epidemiological trends.
为应对长期护理需求增加而引入的综合护理干预措施，给卫生人力带来了深刻变革。本探索性研究旨在概述作为综合慢性病护理干预措施一部分而实施的人力变革情况。
采用了一种交互式和动态的研究设计，包括文献综述、定性专家问卷和案例报告。我们将综合护理定义为针对慢性病护理模式六个组成部分中至少两个部分的干预措施。人力变革定义为负责公共和个人健康干预的临床和非临床工作人员所经历的变革。
确定了七项人力变革：（1）护士参与，（2）多学科工作人员，（3）多学科协议/路径，（4）提供者培训，（5）个案经理/护理协调员，（6）团队会议，以及（7）新职位。大多数干预措施包括上述多项人力变革。
本研究结果详细洞察了综合护理干预措施中人力变革的当前实施情况，从而为在复杂干预措施范围内进一步研究不同人力变革的相对有效性铺平了道路。在这一领域推进知识对于增强卫生系统应对当前人口和流行病学趋势相关挑战的能力至关重要。
