School of Nursing, York University, Toronto, Ontario, Canada.
York University Centre for Aging Research and Education, York University, Toronto, Ontario, Canada.
BMJ Open. 2019 May 24;9(5):e028050. doi: 10.1136/bmjopen-2018-028050.
Faced with costly hospital readmissions of increasingly complex patient populations, transitional care is a priority throughout Ontario, Canada; yet, rural patients have significantly more hospital readmissions and emergency department visits during the first 30 days following hospitalisation than urban patients. Because transitional care (TC) was designed and evaluated with urban patients, addressing urban-rural disparities in TC effectiveness requires increasing the alignment of TC with the needs of patients and families in rural communities and the rural nursing practice context. The study objectives are to (1) determine the perceived acceptability of evidence-based TC interventions targeting postdischarge care management to patients, families and nurses and (2) adapt the interventions to patients' and families' needs and the rural nursing practice context.
This multimethod study has two phases. In phase I, 32-48 patients and families will rate their level of preparedness for discharge and the acceptability of evidence-based TC interventions. Participants will be engaged in semi-structured interviews about their care management needs, their perspectives on the interventions in fitting those needs and in providing suggestions for adapting the interventions to fit their needs. TC interventions perceived as acceptable to patients and families will be examined in phase II. In phase II, 32-48 hospital and home care nurses will rate the acceptability of the interventions identified by patients and families and attend focus group discussions on the feasibility of providing the interventions. Phase I and II data will be analysed using descriptive statistics and qualitative content analysis.
Ethics approval was obtained from the Research Ethics Board at York University and participating hospital sites. Findings will be communicated through plain language fact sheets, policy briefs, press-releases and peer-reviewed conference presentations and manuscripts.
面对日益复杂的患者群体，高昂的住院费用，安大略省（加拿大）各地都将过渡护理作为优先事项；然而，与城市患者相比，农村患者在住院后 30 天内的医院再入院率和急诊就诊率明显更高。由于过渡护理（TC）是为城市患者设计和评估的，因此要解决 TC 在农村患者中的有效性方面的城乡差异，就需要使 TC 更加符合农村社区患者及其家庭以及农村护理实践环境的需求。研究的目的是：（1）确定针对出院后护理管理的基于证据的 TC 干预措施对患者、家庭和护士的可接受性；（2）使干预措施适应患者及其家庭的需求以及农村护理实践环境。
这项多方法研究分为两个阶段。在第一阶段，32-48 名患者及其家庭将评估其出院准备情况以及对基于证据的 TC 干预措施的可接受性。将对参与者进行半结构化访谈，了解他们的护理管理需求、他们对符合这些需求的干预措施的看法，以及对调整这些干预措施以符合其需求的建议。在第二阶段，将检查患者和家庭认为可以接受的 TC 干预措施。在第二阶段，32-48 名医院和家庭护理护士将评估患者和家庭确定的干预措施的可接受性，并参加关于提供这些干预措施的可行性的焦点小组讨论。将使用描述性统计和定性内容分析来分析第一阶段和第二阶段的数据。
约克大学和参与的医院网站的伦理审查委员会已批准了该研究。研究结果将通过通俗易懂的情况说明书、政策简报、新闻稿以及同行评议的会议报告和论文进行传播。
