Möckli Nathalie, Simon Michael, Meyer-Massetti Carla, Pihet Sandrine, Fischer Roland, Wächter Matthias, Serdaly Christine, Zúñiga Franziska
Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
Nursing Research Unit, Inselspital Bern, Freiburgstrasse 18, CH-3010, Bern, Switzerland.
BMC Health Serv Res. 2021 Apr 6;21(1):306. doi: 10.1186/s12913-021-06294-7.
The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited.
This study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies' structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care.
This study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees' working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses.
The first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.
家庭医疗保健持续分散，这反映出护理提供者之间协调不足。然而，尽管系统层面（如法规）和组织层面（如工作环境）的因素对家庭护理组织、协调以及最终的质量有着至关重要的影响，但在家庭护理环境中，对这些因素及其相互关系的了解仍然有限。
本研究有三个目标：[1]探讨系统层面的法规如何导致家庭护理机构的结构、流程和工作环境之间存在差异；[2]探讨系统层面和组织层面的因素如何影响机构层面的家庭护理协调；[3]探讨机构层面的护理协调与患者层面的护理质量之间的关系。
本研究聚焦于瑞士家庭护理环境下的一项全国多中心横断面调查。它将针对100个家庭护理机构、其员工和客户进行招募，计划于2021年1月至6月进行数据收集。我们将评估法规和融资机制（通过公共记录）、机构特征（通过机构问卷数据）以及家庭护理员工的工作环境和协调活动，以及员工和患者层面对于协调和护理质量的看法（通过针对家庭护理员工、客户和非正式护理人员的问卷）。所有收集到的数据将进行描述性和多层次分析。
预计在2021年12月得出初步结果。了解与护理质量相关的因素对于规划和实施质量改进策略至关重要。本研究将有助于识别多个卫生系统层面的可改变因素，这些因素可能成为改善协调和护理质量的切入点。
