关节炎护理模式：作为护理质量维度的可接受性的系统评估。

Models of Arthritis Care: A Systems-level Evaluation of Acceptability as a Dimension of Quality of Care.

机构信息

From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.

E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary.

出版信息

J Rheumatol. 2020 Sep 1;47(9):1431-1439. doi: 10.3899/jrheum.190501. Epub 2019 Nov 15.

DOI:10.3899/jrheum.190501

PMID:31732557

Abstract

OBJECTIVE

To describe a systems-level baseline evaluation of central intake (CI) and triage systems in arthritis care within Alberta, Canada. The specific objectives were to (1) describe a process for systems evaluation for the provision of arthritis care; (2) report the findings of the evaluation for different clinical sites that provide arthritis care; and (3) identify opportunities for improving appropriate and timely access based on the findings of the evaluation.

METHODS

The study used a convergent mixed methods design. Surveys and semistructured interviews were the main data collection methods. Participants were recruited through 2 rheumatology clinics and 1 hip and knee clinic providing CI and triage, and included patients, referring physicians, specialists, and clinic staff who experienced CI processes.

RESULTS

A total of 237 surveys were completed by patients (n = 169), referring physicians (n = 50), and specialists (n = 18). Interviews (n = 25) with care providers and patients provided insights to the survey data. Over 95% of referring physicians agreed that the current process of CI was satisfactory. Referring physicians and specialists reported issues with the referral process and perceived support in care for wait-listed patients. Patients reported positive experiences with access and navigation of arthritis care services but expressed concerns around communication and receiving minimal support for self-management of their arthritis before and after receiving specialist care.

CONCLUSION

This baseline evaluation of CI and triage for arthritis care indicates satisfaction with the service, but areas that require further consideration are referral completion, timely waiting lists, and further supporting patients to self-manage their arthritis.

摘要

目的

描述加拿大艾伯塔省关节炎护理中心的集中受理（CI）和分诊系统的系统级基准评估。具体目标是：(1) 描述提供关节炎护理的系统评估过程；(2) 报告为提供关节炎护理的不同临床站点评估的结果；(3) 根据评估结果确定改善适当和及时获得服务的机会。

方法

该研究采用了收敛混合方法设计。调查和半结构化访谈是主要的数据收集方法。参与者是通过 2 个风湿病诊所和 1 个髋关节和膝关节诊所招募的，这些诊所提供 CI 和分诊服务，包括经历 CI 流程的患者、转诊医生、专家和诊所工作人员。

结果

共有 237 名患者（n = 169）、转诊医生（n = 50）和专家（n = 18）完成了调查。对护理提供者和患者进行的 25 次访谈提供了对调查数据的深入了解。超过 95%的转诊医生同意当前的 CI 流程令人满意。转诊医生和专家报告了转诊流程存在问题，并认为等待名单上的患者的护理支持不足。患者对关节炎护理服务的获取和导航体验表示积极，但对沟通和在接受专科护理前后接受最小的关节炎自我管理支持表示担忧。