Department of Family Medicine, University of Alberta, T6G 2T4, Edmonton, AB, Canada.
Accelerating Change Transformations Team, Alberta Medical Association, T5N 3Y8, Edmonton, AB, Canada.
Can J Gastroenterol Hepatol. 2021 Jun 15;2021:5582297. doi: 10.1155/2021/5582297. eCollection 2021.
Gaps in coordination and transitions of care for liver cirrhosis contribute to high rates of hospital readmissions and inadequate quality of care. Understanding the differences in the mental models held by specialty and primary care physicians may help to identify the root causes of problems in the coordination of cirrhosis care.
To compare and identify differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions.
Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling to select family physicians ( = 8), specialists ( = 9), and cirrhosis-dedicated nurse practitioners ( = 2) across Alberta.
Family physicians do not maintain rich mental models of cirrhosis care. They see cirrhosis patients relatively infrequently, rebuilding their mental models when required (knowledge on demand). They have reactive and patient-need-focused, rather than proactive and system-of-care, mental models. Specialists' mental models are rich but vary widely between patient-centered and task-centered and in the degree to which they incorporate responsibility for addressing system gaps. Nurse practitioners hold patient-centered mental models like specialists but take responsibility for addressing gaps in the system.
Improving the coordination of cirrhosis care will require infrastructure to design care pathways and work processes that will support family physicians' knowledge-on-demand needs, facilitate primary care-specialist relationships, and deliberately work toward building a shared mental model of responsibilities for addressing medical care and social determinants of health.
肝硬化患者的护理在协调和交接方面存在不足，导致住院再入院率高，护理质量不达标。了解专科医生和初级保健医生在思维模式上的差异，有助于找出肝硬化护理协调方面问题的根本原因。
比较并确定初级保健医生和专科医生以及肝硬化专科护士在肝硬化护理思维模式上的差异，这些差异可能是改善协调和交接的关键。
使用认知任务分析对肝硬化护理的思维模型进行跨学科的正式探究。在艾伯塔省选择家庭医生（n=8）、专家（n=9）和专门治疗肝硬化的护士从业者（n=2），采用目的性和连锁式抽样。
家庭医生对肝硬化护理的思维模型并不完善。他们很少见到肝硬化患者，只有在需要时才会重新构建他们的思维模型（按需知识）。他们的思维模式是被动的，以患者需求为中心，而不是主动的，以整个护理系统为中心。专家的思维模型虽然丰富，但差异很大，既有以患者为中心的，也有以任务为中心的，还有的专家将责任完全集中在解决系统差距上。护士从业者的思维模式与专家相似，都是以患者为中心，但他们还承担着解决系统差距的责任。
要改善肝硬化护理的协调，需要建立基础设施，设计护理路径和工作流程，以满足家庭医生的按需知识需求，促进初级保健与专科医生的关系，并有意建立一个共同的责任思维模式，以解决医疗和健康的社会决定因素问题。
