From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
J Patient Saf. 2021 Dec 1;17(8):e727-e731. doi: 10.1097/PTS.0000000000000664.
Successful efforts to improve transitional care depend in part on local attitudes, workload, and training. Before implementing a multifaceted transitions intervention within an Accountable Care Organization, an understanding of contextual factors among providers involved in care transitions in inpatient and outpatient settings was needed.
As part of the Partners-Patient-Centered Outcomes Research Institute (PCORI) Transitions Study, we purposefully sampled inpatient and outpatient providers within the Accountable Care Organization. Survey questions focused on training and feedback on transitional tasks and opinions on the quality of care transitions. We also surveyed unit- and practice-level leadership on current transitional care practices. Results are presented using descriptive statistics.
Among 387 providers surveyed, 220 responded (response rate = 57%) from 15 outpatient practices and 26 inpatient units. A large proportion of respondents reported to have never received training (50%) or feedback (68%) on key transitional care activities, and most (58%) reported insufficient time to complete these tasks. Respondents on average reported transitions processes led to positive outcomes some to most of the time (mean scores = 4.70-5.16 on a 1-7 scale). Surveys of leadership showed tremendous variation by unit and by practice in the performance of various transitional care activities.
Many respondents felt that training, feedback, and time allotted to key transitional care activities were inadequate. Satisfaction with the quality of the transitions process was middling. Understanding these results, especially variation by location, was important to customizing implementation of the intervention and will be key to understanding variation in the success of the intervention across locations.
成功改善过渡护理在一定程度上取决于当地的态度、工作量和培训。在医疗机构实施多方面的过渡干预措施之前，需要了解参与住院和门诊环境中过渡护理的提供者的背景因素。
作为合作伙伴-患者为中心的成果研究所（PCORI）过渡研究的一部分，我们有目的地在医疗机构中选择住院和门诊提供者。调查问题集中在过渡任务的培训和反馈以及对过渡护理质量的看法上。我们还调查了单位和实践层面的领导关于当前过渡护理实践的情况。结果以描述性统计数据呈现。
在接受调查的 387 名提供者中，有 220 名（回应率=57%）来自 15 个门诊实践和 26 个住院病房的提供者做出了回应。很大一部分受访者表示从未接受过关键过渡护理活动的培训（50%）或反馈（68%），大多数（58%）表示完成这些任务的时间不足。受访者平均报告过渡过程在某些时候导致了积极的结果（在 1-7 的量表上平均得分=4.70-5.16）。对领导层的调查显示，各单位和各实践在各种过渡护理活动的表现上存在巨大差异。
许多受访者认为关键过渡护理活动的培训、反馈和分配的时间都不足。对过渡过程质量的满意度中等。了解这些结果，特别是位置上的差异，对于定制干预措施的实施非常重要，这也是理解干预措施在不同地点成功的关键。
