Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado.
Canandaigua Veterans Affairs Medical Center, Canandaigua, New York.
J Am Geriatr Soc. 2019 Dec;67(12):2511-2518. doi: 10.1111/jgs.16171. Epub 2019 Oct 8.
BACKGROUND/OBJECTIVES: The US Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) Program provides interdisciplinary, long-term primary care for frail, disabled, or chronically ill veterans. This research identifies strategies used by HBPC teams to support veterans in their homes, rather than in institutionalized care. DESIGN: Focus groups and semistructured interviews were conducted with HBPC interdisciplinary team (IDT) members, including program directors, medical directors, and key staff, from September 2017 to March 2018. Field observations were gathered during visits to veterans' homes and IDT meetings. SETTING: In-person site visits were conducted at eight HBPC Programs across the United States. Sites varied in location, setting, and primary care model. PARTICIPANTS: A total of 105 HBPC professionals. MEASUREMENT: Qualitative thematic content analysis. RESULTS: Four main strategies drive and support the shared mission of IDTs to support veterans at home: fostering frequent communication among IDT members, veterans, caregivers, and outside agencies; development of longitudinal, trusting, reliable relationships within IDTs and with veterans and caregivers; ongoing, consistent education for IDT members and veterans and caregivers; and collaboration within and outside IDTs. Adhering to this mission meant providing timely and efficient care that kept veterans in their homes and minimized the need for acute hospitalizations and nursing home placement. CONCLUSION: HBPC IDTs studied worked together across disciplines to effectively create a dedicated culture of caring for veterans, caregivers, and themselves, leading to keeping veterans at home. Focusing on the strategies identified in this research may be useful to achieve similar positive outcomes when caring for medically complex, homebound patients within and outside the VA. J Am Geriatr Soc 67:2511-2518, 2019.
背景/目的:美国退伍军人事务部(VA)的家庭为基础的初级保健(HBPC)计划为虚弱、残疾或慢性病老兵提供跨学科的长期初级保健。这项研究确定了 HBPC 团队用于支持在家中而不是在机构化护理中的退伍军人的策略。
设计:2017 年 9 月至 2018 年 3 月,对 HBPC 跨学科团队(IDT)成员,包括项目主任、医疗主任和主要工作人员,进行了焦点小组和半结构化访谈。在访问退伍军人家庭和 IDT 会议期间收集了实地观察资料。
地点:在美国八个 HBPC 计划中进行了现场考察。这些地点在地点、环境和初级保健模式上存在差异。
参与者:共有 105 名 HBPC 专业人员。
测量:定性主题内容分析。
结果:有四个主要策略推动和支持 IDT 的共同使命,即支持在家中的退伍军人:促进 IDT 成员、退伍军人、照顾者和外部机构之间的频繁沟通;在 IDT 内部以及与退伍军人和照顾者建立长期、信任、可靠的关系;为 IDT 成员和退伍军人以及照顾者提供持续、一致的教育;以及在 IDT 内部和外部进行合作。坚持这一使命意味着提供及时、高效的护理,使退伍军人留在家里,最大限度地减少对急性住院和疗养院安置的需求。
结论:研究中的 HBPC IDT 跨学科合作,有效地为退伍军人、照顾者和他们自己创造了一种专注的关爱文化,使退伍军人留在家里。关注本研究中确定的策略,在 VA 内外照顾病情复杂、居家的患者时,可能有助于取得类似的积极结果。美国老年学会杂志 67:2511-2518, 2019。
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