我们是否在医疗保健服务的过渡中“忽视了大局”？管理非计划性住院患者的医疗保健提供者的观点。
Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization.
机构信息
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Evidera, Waltham, MA, USA.
出版信息
Appl Nurs Res. 2018 Dec;44:60-66. doi: 10.1016/j.apnr.2018.09.006. Epub 2018 Sep 19.
BACKGROUND
Healthcare providers play a critical role in the care transitions. Therefore, efforts to improve this process should be informed by their perspectives.
AIM
The study objective was to explore the factors that negatively/positively influence care transitions following an unplanned hospitalization from the perspective of healthcare providers.
METHODS
A qualitative study using semi-structured interviews conducted between February and September of 2016 at a single academic medical center. We enrolled fifteen healthcare providers from multiple disciplines involved in the management of patients experiencing an unplanned hospitalization. Respondents shared their experiences with care transitions and identified factors within and outside of the discharging health facility that impede or facilitate this process. Transcribed interviews were analyzed using emerging themes from the interviews.
RESULTS
We identified six themes and associated subthemes from the interviews on factors that influence care transitions. Three themes focused on factors within the discharging healthcare facility: untailored and overloaded patient discharge information, timing of the post-discharge care conversation, provider-to-patient and provider-to-provider miscommunication. The other three themes were related to external factors including caregiver involvement, having a safe and stable housing environment, and access to healthcare and community resources. Providers discussed how these factors positively/negatively influence the hospital-to-home transition.
CONCLUSIONS
Our study identifies factors within and outside the discharging healthcare facility that influence care transitions, ultimately affect patient-centered outcomes and provider satisfaction with delivered care. Strategies aimed at improving the quality of care transitions should address these barriers and actively engage healthcare providers who are pivotal in care transitions.
背景
医疗保健提供者在医疗保健转移中发挥着关键作用。因此，改善这一过程的努力应该基于他们的观点。
目的
本研究旨在从医疗保健提供者的角度探讨影响计划外住院后医疗保健转移的负面/正面因素。
方法
这是一项在 2016 年 2 月至 9 月期间在一家学术医疗中心进行的半结构式访谈的定性研究。我们招募了来自多个学科的 15 名参与管理计划外住院患者的医疗保健提供者。受访者分享了他们在医疗保健转移方面的经验，并确定了出院医疗机构内部和外部影响这一过程的因素。对转录的访谈进行了分析，以确定访谈中的新兴主题。
结果
我们从对影响医疗保健转移的因素的访谈中确定了六个主题和相关的子主题。三个主题侧重于出院医疗机构内部的因素：量身定制和超负荷的患者出院信息、出院后护理谈话的时间、医患和医护之间的沟通失误。另外三个主题与外部因素有关，包括照顾者的参与、安全稳定的住房环境以及获得医疗保健和社区资源的机会。提供者讨论了这些因素如何对医院到家庭的转移产生正面/负面影响。
结论
我们的研究确定了出院医疗机构内部和外部影响医疗保健转移的因素，最终影响以患者为中心的结果和提供者对提供的护理的满意度。旨在提高医疗保健转移质量的策略应解决这些障碍，并积极吸引在医疗保健转移中至关重要的医疗保健提供者。
Zotero 插件