Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
Implement Sci. 2021 Feb 26;16(1):21. doi: 10.1186/s13012-021-01087-2.
Care transitions of older persons between multiple care settings are frequently hampered by various issues such as discontinuous care delivery or poor information transfer among healthcare providers. Therefore, several innovations have been developed to optimize transitional care (TC). This review aims to identify which factors influence the implementation of TC innovations.
As part of TRANS-SENIOR, an international innovative training and research network focusing on enhancing or avoiding care transitions, a scoping review was conducted. The five stages of the Arksey and O'Malley framework were followed. PubMed/MEDLINE, EMBASE, and CINAHL were searched, and eligible studies published between years 2000 and 2020 were retrieved. Data were extracted from the included studies and mapped to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and Care Transitions Framework (CTF).
Of 1537 studies identified, 21 were included. Twenty different TC innovations were covered and aimed at improving or preventing transitions between multiple care settings, the majority focused on transitions from hospital to home. Key components of the innovations encompassed transition nurses, teach-back methods, follow-up home visits, partnerships with community services, and transfer units. Twenty-five prominent implementation factors (seven barriers, seven facilitators, and eleven factors with equivalent hindering/facilitating influence) were shown to affect the implementation of TC innovations. Low organizational readiness for implementation and the overall implementation climate were topmost hindering factors. Similarly, failing to target the right population group was commonly reported as a major barrier. Moreover, the presence of skilled users but with restricted knowledge and mixed attitudes about the innovation impeded its implementation. Among the eminent enabling factors, a high-perceived advantage of the innovation by staff, along with encouraging transition roles, and a continuous monitoring process facilitated the implementation of several innovations. Other important factors were a high degree of organizational networks, engaging activities, and culture; these factors had an almost equivalent hindering/facilitating influence.
Addressing the right target population and instituting transition roles in care settings appear to be specific factors to consider during the implementation of TC innovations. Long-term care settings should simultaneously emphasize their organizational readiness for implementation and change, in order to improve transitional care through innovations.
老年人在多个护理环境之间的护理交接常受到各种问题的阻碍，例如护理提供方之间的护理服务不连续或信息传递不良。因此，已经开发了几种创新方法来优化过渡护理（TC）。本综述旨在确定影响 TC 创新实施的因素。
作为专注于增强或避免护理交接的国际创新培训和研究网络 TRANS-SENIOR 的一部分，进行了范围综述。采用阿特金森和奥马利框架的五个阶段。检索了 PubMed/MEDLINE、EMBASE 和 CINAHL，并检索了 2000 年至 2020 年期间发表的合格研究。从纳入的研究中提取数据，并映射到实施研究综合框架（CFIR）和护理交接框架（CTF）的领域和结构。
在确定的 1537 项研究中，有 21 项研究被纳入。涵盖了 20 种不同的 TC 创新，旨在改善或预防多个护理环境之间的交接，其中大多数专注于从医院到家庭的交接。创新的关键组成部分包括交接护士、回授方法、随访家访、与社区服务的伙伴关系以及转科病房。显示有 25 个突出的实施因素（7 个障碍、7 个促进因素和 11 个具有同等阻碍/促进影响的因素）会影响 TC 创新的实施。低组织实施准备度和整体实施氛围是最主要的阻碍因素。同样，未能针对正确的人群群体也是常见的主要障碍。此外，存在熟练的用户，但对创新的知识有限且态度混杂，这也阻碍了创新的实施。在突出的促进因素中，工作人员对创新的高度感知优势，以及鼓励的交接角色和持续的监测过程，促进了多项创新的实施。其他重要因素是高度的组织网络、参与活动和文化；这些因素具有几乎同等的阻碍/促进影响。
在实施 TC 创新时，针对正确的目标人群并在护理环境中建立交接角色似乎是需要考虑的特定因素。长期护理环境应同时强调其实施准备度和变革，以通过创新来改善过渡护理。
