Department of Health Policy and Management, University of Pittsburgh, Pennsylvania.
Health Policy Institute, University of Pittsburgh, Pennsylvania.
Gerontologist. 2020 May 15;60(4):776-786. doi: 10.1093/geront/gnz011.
The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act's three components into routine care delivery.
We conducted a multisite, ethnographic case study at three different hospitals' medical-surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework.
Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements.
General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.
宾夕法尼亚州于 2016 年 4 月 20 日通过了《护理人员咨询、记录、授权（CARE）法案》。我们设计了一项研究，旨在探索大型综合交付融资系统的早期实施情况。我们的目标是评估系统层面的决策对单位实施的影响，以及将 CARE 法案的三个组成部分纳入常规护理服务的情况。
我们在三家不同医院的医疗外科病房进行了一项多地点、民族志案例研究。我们进行了观察和半结构化访谈，以了解实施过程以及护理人员识别、通知和教育的方法。我们使用主题分析对访谈和观察进行编码，并将研究结果与促进卫生服务研究实施行动框架联系起来。
组织背景和电子健康记录能力对 CARE 法案的实施和融入工作流程至关重要。实施团队采用了分散化策略和多种沟通模式，依靠当地医院单位培训员工并进行变革。我们发现，该系统通过强调文档记录和图表记录，以证明符合法律要求，从而促进了 CARE 法案的实施。
一般急症医院将在如何实施监管要求和证明符合 CARE 法案方面做出或已经做出类似的决策。本研究可以为其他人设计和改进合规和实施策略提供信息。
