Geisinger Obesity Institute, Geisinger Health System, Danville, PA, USA.
Nutritional Sciences, Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA.
Transl Behav Med. 2018 Nov 21;8(6):944-952. doi: 10.1093/tbm/ibx046.
New care delivery models call for integrating health services to coordinate care and improve patient-centeredness. Such models have been embraced to coordinate care with evidence-based strategies to prevent obesity. Both the Special Supplemental Program for Women, Infants and Children (WIC) Program and pediatricians are considered credible sources of preventive guidance, and coordinating these independent siloes would benefit a vulnerable population. Using semistructured focus groups and interviews, we evaluated practices, messaging, and the prospect of integrating and coordinating care. Across Pennsylvania, WIC nutritionists (n = 35), pediatricians (n = 15), and parents (N = 28) of an infant or toddler participated in 2016. Three themes were identified: health assessment data sharing (e.g., iron, growth measures), benefits and barriers to integrated health services, and coordinating care to reduce conflicting educational messages (e.g., breastfeeding, juice, introduction of solids). Stakeholders supported sharing health assessment data and integrating health services as strategies to enhance the quality of care, but were concerned about security and confidentiality. Overall, integrated, coordinated care was perceived to be an acceptable strategy to facilitate consistent, preventive education and improve patient-centeredness.
新的医疗服务模式要求整合卫生服务,以协调护理并提高以患者为中心的服务水平。这些模式已被采用,以结合循证策略来协调预防肥胖的护理。妇女、婴儿和儿童特别补充营养计划(WIC)和儿科医生都被认为是预防指导的可靠来源,协调这些独立的部门将使弱势群体受益。我们使用半结构化焦点小组和访谈评估了实践、信息传递,以及整合和协调护理的前景。在宾夕法尼亚州,2016 年有 35 名 WIC 营养学家、15 名儿科医生和 28 名婴儿或幼儿的父母参与了研究。确定了三个主题:健康评估数据共享(例如,铁、生长测量)、整合卫生服务的益处和障碍,以及协调护理以减少相互矛盾的教育信息(例如,母乳喂养、果汁、固体食物的引入)。利益相关者支持共享健康评估数据和整合卫生服务,将其作为提高护理质量的策略,但他们关注的是安全和保密性。总的来说,整合协调的护理被认为是一种可接受的策略,可以促进一致的、预防性的教育,并提高以患者为中心的服务水平。