Duke University Department of Population Health Sciences.
Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System.
Med Care. 2021 Nov 1;59(11):961-969. doi: 10.1097/MLR.0000000000001622.
Home-based and community-based health care for individuals with complex medical conditions is often provided by family caregivers. Yet caregivers often are not meaningfully included in interactions with clinical health care teams. Inclusive care means inviting the caregiver to participate in shared decision-making and treatment planning. For aging or medically vulnerable adults, caregiver inclusion is an important facet of patient-centered care.
We apply a mixed-methods approach using a survey (n=50) and semistructured interview data (n=13) from a national sample of caregivers of veterans and semistructured interview data from (n=24) providers from 3 Veterans Affairs regional networks. We elicited data from caregivers about their experiences with inclusive care and how providers communicate with them and assess their capacity. We juxtaposed these data with provider perspectives to see where there was alignment.
We determined that caregivers play important roles in trust-building, communications management, implementation of care plans at home or in the community, and improving the care of care recipients-while maintaining a balance between competing tensions.
Our findings suggest that expanding inclusive care could improve care quality and health outcomes of individuals with complex health care needs. Further, our findings bolster recent policy efforts at the federal and state levels to increase recognition of caregivers as key members of the health care team.
为患有复杂疾病的个体提供家庭和社区医疗服务通常由家庭照顾者承担。然而，照顾者在与临床医疗保健团队的互动中往往没有得到充分的重视。包容性护理意味着邀请照顾者参与共同决策和治疗计划。对于老年人或医学上脆弱的成年人来说，照顾者的参与是患者为中心护理的一个重要方面。
我们采用混合方法，使用全国退伍军人照顾者样本的调查（n=50）和半结构化访谈数据（n=13），以及来自 3 个退伍军人事务地区网络的（n=24）提供者的半结构化访谈数据。我们从照顾者那里收集有关他们在包容性护理方面的经验，以及提供者如何与他们沟通和评估他们的能力的数据。我们将这些数据与提供者的观点进行对比，以了解哪些方面存在一致性。
我们确定照顾者在建立信任、沟通管理、在家庭或社区中实施护理计划以及改善护理对象的护理方面发挥着重要作用，同时在竞争的紧张关系之间保持平衡。
我们的研究结果表明，扩大包容性护理可以提高有复杂医疗需求的个体的护理质量和健康结果。此外，我们的研究结果支持了联邦和州层面最近为增加对照顾者作为医疗保健团队关键成员的认可而做出的政策努力。
