Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA.
J Am Geriatr Soc. 2021 Feb;69(2):300-306. doi: 10.1111/jgs.16952. Epub 2020 Nov 20.
BACKGROUND/OBJECTIVES: COVID-19 required rapid innovation throughout the healthcare system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was to determine strategies used by New York City (NYC)-area HBPC practices to provide patient care during the first wave of the COVID-19 pandemic with the goal of informing planning and preparation for home-based practices nationwide.
Cross-sectional qualitative design using semi-structured interviews.
HBPC practices in the NYC metro area during spring 2020.
HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators, and social workers/social work coordinators (n = 13) at 6 NYC-area practices.
Semi-structured interviews explored HBPC practices' COVID-19 care delivery challenges, adaptations, and advice for providers. Interviewers probed patient care, end-of-life care, telehealth, community-based services and staffing. Interviews were recorded and transcribed. Data were analyzed through a combined inductive and deductive thematic approach.
Participants described care delivery and operational adaptations similar to those universally adopted across healthcare settings during COVID-19, such as patient outreach and telehealth. HBPC-specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in-person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long-standing patients.
NYC-area HBPC providers adapted care delivery and operations rapidly during the height of the COVID-19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork, and partnerships with outside providers. As the pandemic continues to surge around the United States, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.
背景/目的：COVID-19 要求整个医疗系统迅速创新。家庭初级保健 (HBPC) 实践面临着独特的挑战，需要为医疗复杂的老年人群提供服务，他们需要将传统的动手模式转变为适应限制身体接触的模式。我们的目的是确定纽约市 (NYC) 地区 HBPC 实践在 COVID-19 大流行第一波期间提供患者护理的策略，旨在为全国范围内的家庭实践提供规划和准备工作提供信息。
使用半结构式访谈的横截面定性设计。
2020 年春季纽约市大都市区的 HBPC 实践。
6 家纽约市地区实践的 HBPC 领导层，包括临床/医疗主任、项目管理人员、执业护士/护理协调员和社会工作者/社会工作协调员（n = 13）。
半结构式访谈探讨了 HBPC 实践在 COVID-19 护理方面面临的挑战、适应措施以及为提供者提供的建议。访谈员探讨了患者护理、临终关怀、远程医疗、基于社区的服务和人员配备。采访进行了录音和转录。通过归纳和演绎主题相结合的方法对数据进行分析。
参与者描述了与 COVID-19 期间整个医疗保健环境普遍采用的护理提供和运营适应措施类似的措施，例如患者外展和远程医疗。HBPC 特定的适应措施包括为经历抑郁和孤立的患者提供心理健康服务，使用多种患者互动模式来平衡虚拟护理与必要的身体接触，维持患者信任的策略，以及通过日常小组讨论和在长期患者死亡激增期间提供情感支持来支持员工团队联系。
在 COVID-19 大流行高峰期，纽约市地区 HBPC 提供者迅速调整了护理提供和运营。让年龄较大、医疗复杂的患者安全在家中需要相当大的灵活性、透明度、团队合作和与外部提供者的合作。随着美国各地的大流行继续激增，HBPC 提供者可以应用这些经验教训，并考虑为未来的挑战做好准备所需的资源。
