家庭中急性病成年人的医院级护理：一项随机对照试验的定性评估。
Hospital-Level Care at Home for Acutely Ill Adults: a Qualitative Evaluation of a Randomized Controlled Trial.
机构信息
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
出版信息
J Gen Intern Med. 2021 Jul;36(7):1965-1973. doi: 10.1007/s11606-020-06416-7. Epub 2021 Jan 21.
BACKGROUND
Substitutive hospital-level care in a patient's home ("home hospital") has been shown to lower cost, utilization, and readmission compared to traditional hospital care. However, patients' perspectives to help explain how and why interventions like home hospital accomplish many of these results are lacking.
OBJECTIVE
Elucidate and explain patient perceptions of home hospital versus traditional hospital care to better describe the different perceptions of care in both settings.
DESIGN
Qualitative evaluation of a randomized controlled trial.
PARTICIPANTS
36 hospitalized patients (19 home; 17 control).
INTERVENTION
Traditional hospital ("control") versus home hospital ("home"), including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing.
APPROACH
We conducted a thematic content analysis of semi-structured interviews. Team members developed a coding structure through a multiphase approach, utilizing a constant comparative method.
KEY RESULTS
Themes clustered around 3 domains: clinician factors, factors promoting healing, and systems factors. Clinician factors were similar in both groups; both described beneficial interactions with clinical staff; however, home patients identified greater continuity of care. For factors promoting healing, home patients described a locus of control surrounding their sleep, activity, and environmental comfort that control patients lacked. For systems factors, home patients experienced more efficient processes and logistics, particularly around admission and technology use, while both noted difficulty with discharge planning.
CONCLUSIONS
Compared to control patients, home patients had better experiences with their care team, had more experiences promoting healing such as better sleep and physical activity, and had better experiences with systems factors such as the admission processes. Potential explanations include continuity of care, the power and familiarity of the home, and streamlined logistics. Future improvements include enhanced care transitions and ensuring digital interfaces are usable.
TRIAL REGISTRATION
NCT03203759.
背景
在家中为患者提供替代医院级别的护理（“家庭医院”）已被证明可降低成本、利用率和再入院率，优于传统的医院护理。然而，缺乏患者的观点来帮助解释家庭医院等干预措施如何以及为何能实现许多这些结果。
目的
阐明并解释患者对家庭医院与传统医院护理的看法，以更好地描述这两种护理环境的不同看法。
设计
随机对照试验的定性评估。
参与者
36 名住院患者（19 名家庭医院；17 名对照组）。
干预措施
传统医院（“对照组”）与家庭医院（“家庭组”），包括护士和医生家访、静脉用药、远程监测、视频通信和即时检测。
方法
我们对半结构化访谈进行了主题内容分析。团队成员通过多阶段方法制定了编码结构，采用恒定性比较方法。
主要结果
主题围绕 3 个领域聚类：临床医生因素、促进康复的因素和系统因素。两组的临床医生因素相似；两组都描述了与临床工作人员有益的互动；然而，家庭组患者认为护理的连续性更强。在促进康复的因素方面，家庭组患者描述了他们的睡眠、活动和环境舒适度的控制感，而对照组患者则缺乏这种感觉。在系统因素方面，家庭组患者在入院和技术使用等方面经历了更高效的流程和后勤，而两组患者都指出在出院计划方面存在困难。
结论
与对照组患者相比，家庭组患者对其护理团队的体验更好，在促进康复方面的体验更多，如睡眠和身体活动更好，在入院流程等系统因素方面的体验也更好。潜在的解释包括护理的连续性、家庭的力量和熟悉度以及简化的后勤。未来的改进包括加强护理过渡和确保数字接口的可用性。
试验注册
NCT03203759。
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