Desai Arti D, Jacob-Files Elizabeth A, Wignall Julia, Wang Grace, Pratt Wanda, Mangione-Smith Rita, Britto Maria T
Department of Pediatrics, University of Washington, Seattle, Washington;
Seattle Children's Research Institute, Seattle, Washington.
Hosp Pediatr. 2018 Jul;8(7):394-403. doi: 10.1542/hpeds.2017-0242. Epub 2018 Jun 5.
Shared care plans play an essential role in coordinating care across health care providers and settings for children with medical complexity (CMC). However, existing care plans often lack shared ownership, are out-of-date, and lack universal accessibility. In this study, we aimed to establish requirements for shared care plans to meet the information needs of caregivers and providers and to mitigate current information barriers when caring for CMC.
We followed a user-centered design methodology and conducted in-depth semistructured interviews with caregivers and providers of CMC who receive care at a tertiary care children's hospital. We applied inductive, thematic analysis to identify salient themes. Analysis occurred concurrently with data collection; therefore, the interview guide was iteratively revised as new questions and themes emerged.
Interviews were conducted with 17 caregivers and 22 providers. On the basis of participant perspectives, we identified 4 requirements for shared care plans that would help meet information needs and mitigate current information barriers when caring for CMC. These requirements included the following: (1) supporting the accessibility of care plans from multiple locations (eg, cloud-based) and from multiple devices, with alert and search features; (2) ensuring the organization is tailored to the specific user; (3) including collaborative functionality such as real-time, multiuser content management and secure messaging; and (4) storing care plans on a secure platform with caregiver-controlled permission settings.
Although further studies are needed to understand the optimal design and implementation strategies, shared care plans that meet these specified requirements could mitigate perceived information barriers and improve care for CMC.
共享护理计划在为患有复杂疾病的儿童(CMC)协调跨医疗服务提供者和场所的护理方面发挥着重要作用。然而,现有的护理计划往往缺乏共同所有权、过时且缺乏普遍可及性。在本研究中,我们旨在确定共享护理计划的要求,以满足护理人员和提供者的信息需求,并在照顾CMC时减轻当前的信息障碍。
我们遵循以用户为中心的设计方法,对在三级儿童医院接受护理的CMC的护理人员和提供者进行了深入的半结构化访谈。我们应用归纳式主题分析来识别突出主题。分析与数据收集同时进行;因此,随着新问题和主题的出现,访谈指南会反复修订。
对17名护理人员和22名提供者进行了访谈。基于参与者的观点,我们确定了共享护理计划的4项要求,这些要求将有助于满足信息需求,并在照顾CMC时减轻当前的信息障碍。这些要求包括:(1)支持从多个地点(如云平台)和多个设备访问护理计划,并具备提醒和搜索功能;(2)确保组织方式适合特定用户;(3)包括协作功能,如实时多用户内容管理和安全消息传递;(4)将护理计划存储在具有护理人员控制权限设置的安全平台上。
尽管需要进一步研究以了解最佳设计和实施策略,但符合这些特定要求的共享护理计划可以减轻感知到的信息障碍,并改善对CMC的护理。