实施养老院关怀目标沟通创新：一项多案例研究设计。
Implementation of Goals of Care Communication Innovation Among Nursing Homes: A Multiple Case Study Design.
机构信息
Department of Health management & Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, FL, USA.
Division of Geriatric Medicine and Palliative Care Program, University of North Carolina, Chapel Hill, NC, USA.
出版信息
J Am Med Dir Assoc. 2022 Jul;23(7):1215-1220. doi: 10.1016/j.jamda.2021.07.038. Epub 2021 Aug 26.
OBJECTIVE
Nursing homes (NHs) provide care to residents with serious illness and related complex health care needs. As such, discussions about end-of-life care between NH staff and residents and families are necessary to ensure residents receive care consistent with their goals. Interventions such as video decision aids have been developed to promote discussions and improve advance care planning, but few studies have examined how NH characteristics may relate to the implementation of these interventions; such information might lead toward more use of successful interventions. The purpose of this study is to understand NH characteristics that are associated with the implementation of the Goals of Care (GOC) intervention, which combined a video decision aid with a structured discussion to guide decision-making in advanced dementia.
DESIGN
A multiple case study.
SETTING AND PARTICIPANTS
Staff surveys were conducted to examine factors related to implementation effectiveness in 11 NHs in North Carolina that participated in the GOC trial.
METHODS
Questions measured the dependent variable of implementation effectiveness: the consistency and quality of use of the GOC intervention. NH organizational characteristics were measured using publicly available data and an administrator survey. The analysis consisted of pattern matching logic.
RESULTS
High management support aligned with implementation effectiveness within NHs. In addition, the within case pattern analysis indicated additional characteristics related to implementation effectiveness. Facility size, Medicare beds, residents' racial composition, and star rating were related to implementation effectiveness across 6 of the 11 NHs. NH financial resources, such as size and number of Medicare beds, may be important factors for successful implementation.
CONCLUSION AND IMPLICATIONS
NHs seeking to implement advance care planning interventions should focus on within and across NH differences, such as adequate management and financial support prior to implementation to increase the likelihood of implementation effectiveness.
目的
养老院（NHs）为患有严重疾病和相关复杂医疗需求的居民提供护理。因此，需要 NH 工作人员与居民及其家属就临终关怀进行讨论，以确保居民得到符合其目标的护理。已经开发了视频决策辅助工具等干预措施来促进讨论和改善预先护理计划，但很少有研究探讨 NH 特征与这些干预措施的实施之间的关系；此类信息可能有助于更广泛地使用成功的干预措施。本研究的目的是了解与实施“关怀目标”（GOC）干预相关的 NH 特征，该干预措施将视频决策辅助工具与结构化讨论相结合，以指导晚期痴呆症的决策制定。
设计
多案例研究。
地点和参与者
对北卡罗来纳州 11 家参与 GOC 试验的 NH 工作人员进行了调查，以检查与实施效果相关的因素。
方法
问题衡量了实施效果的因变量：GOC 干预的一致性和质量。使用公开数据和管理员调查来衡量 NH 组织特征。分析包括模式匹配逻辑。
结果
高管理层的支持与 NH 内部的实施效果一致。此外，案例内模式分析表明，与实施效果相关的其他特征。设施规模、医疗保险床位、居民的种族构成和星级评定与 11 家 NH 中的 6 家有关。NH 的财务资源，如规模和医疗保险床位数量，可能是成功实施的重要因素。
结论和意义
寻求实施预先护理计划干预措施的 NH 应关注 NH 内部和之间的差异，例如在实施之前提供足够的管理和财务支持，以增加实施效果的可能性。
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