School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
PLoS One. 2019 Jan 22;14(1):e0211024. doi: 10.1371/journal.pone.0211024. eCollection 2019.
Research has shown that adverse events during care transitions from hospital to home can have a significant impact on patients' outcomes, leading to readmission, delayed healing or even death. Gaps exist in the ways of monitoring care during transition periods and there is a need to help organizations better implement and monitor safe person-and family-centered care. Value statements are a way to obtain narratives in lay terms about how well care, treatment and support is organized to meet the needs and preferences of patients/families. The purpose of this study was to identify the value statements that are perceived by decision-makers and patients/families to best signify safe person- and family-centered care during transitions from hospital to home.
Between January and September 2017, a web-based Delphi was used to survey key stakeholders in acute care and home care organizations across Canada.
Decision-makers (n = 22) and patients/families (n = 24) from five provinces participated in the Delphi. Following Round 1, 45 perceived value statements were identified. In Round 2, consensus was received on 33/45 (73.3%) by decision-makers, and 30/45 (66.7%) by patients/families. In Round 3, additional value statements reached consensus in the decision-makers' survey (3) and in the patients/families' survey (2). A total of 30 high priority value statements achieved consensus derived from both the decision-makers' and patients/families' perspectives.
This study was an important first step in identifying key consensus-based priority value statements for monitoring care transitions from the perspective of both decision-makers and patients/families. Future research is needed to test their usability and to determine whether these value statements are actually suggestive of safe person-and family-centered care transition interventions from hospital to home.
研究表明，从医院到家庭的护理交接过程中发生的不良事件会对患者的结果产生重大影响，导致再次入院、延迟愈合甚至死亡。在过渡期间监测护理的方式存在差距，需要帮助组织更好地实施和监测安全的以患者和家庭为中心的护理。价值陈述是一种以通俗易懂的方式获取关于护理、治疗和支持如何组织以满足患者/家庭的需求和偏好的叙述的方式。本研究的目的是确定决策者和患者/家庭认为最能体现从医院到家庭的过渡期间以患者和家庭为中心的安全护理的价值陈述。
在 2017 年 1 月至 9 月期间，使用基于网络的德尔菲法调查了加拿大各地急性护理和家庭护理组织的主要利益相关者。
来自五个省的决策者（n=22）和患者/家庭（n=24）参加了德尔菲法。在第一轮中，确定了 45 个被认为具有价值的陈述。在第二轮中，决策者达成共识的有 33/45（73.3%），患者/家庭达成共识的有 30/45（66.7%）。在第三轮中，决策者调查（3）和患者/家庭调查（2）中又有其他价值陈述达成共识。总共从决策者和患者/家庭两个角度达成共识的有 30 个高优先级价值陈述。
本研究从决策者和患者/家庭的角度确定了关键的基于共识的优先价值陈述，这是识别监测从医院到家庭的护理交接的重要的第一步。未来的研究需要测试它们的可用性，并确定这些价值陈述是否实际上暗示了从医院到家庭的安全的以患者和家庭为中心的护理交接干预措施。
