Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Center for Home Care Policy & Research, New York, New York, USA.
J Am Geriatr Soc. 2022 Jan;70(1):218-227. doi: 10.1111/jgs.17492. Epub 2021 Oct 7.
Home health clinicians report a need for family caregiver assistance during the majority of skilled home health care episodes. Since 2018, the Medicare Conditions of Participation has required home health agencies to provide training to family caregivers. However, little is known regarding current practices of family caregiver assessment and training during home health care.
Qualitative research relying on semistructured key informant interviews with registered nurses and physical therapists (n = 19), hereafter "clinicians," from four home health agencies. Interviews were recorded and transcribed, then analyzed using directed content analysis to identify relevant themes and concepts.
Three agencies were not-for-profit and one was for-profit; three were urban and one was rural; two operated on a local scale, one on a regional scale, and one on a national scale. Key informants had an average of 9.3 years of experience in home health care and an average age of 45.0 years. Clinicians described a cyclic process of family caregiver training including four major phases: initial assessment, education, reassessment, and adjustment. Initial assessment was informal and holistic; education was delivered via demonstration and teach-back; reassessment was used to evaluate caregiver progress and inform adjustments to the care plan. Clinicians noted that their perceptions regarding the success of family caregiver training efforts influenced decisions relating to clinical practice, including the number of visits provided and whether to discharge the patient.
Caregiver training is currently integrated into clinician workflows in home health care and helps determine visit intensity and discharge timing, but clinicians face a lack of structured assessment instruments or training materials. Efforts by policymakers and home health agencies to facilitate clinicians' training efforts could positively affect the cost and quality of Medicare-funded home health care.
家庭健康临床医生报告说，在大多数熟练的家庭健康护理期间都需要家庭照顾者的协助。自 2018 年以来，医疗保险条件的参与要求家庭健康机构为家庭照顾者提供培训。然而，对于家庭健康护理期间家庭照顾者评估和培训的当前实践知之甚少。
依赖于对来自四个家庭健康机构的注册护士和物理治疗师（简称“临床医生”，n=19）的半结构化关键知情人访谈的定性研究。访谈进行了录音和转录，然后使用定向内容分析进行分析，以确定相关主题和概念。
三个机构是非营利性的，一个是营利性的；三个是城市的，一个是农村的；两个机构在本地运营，一个在区域范围内运营，一个在全国范围内运营。关键知情人在家居健康护理方面平均有 9.3 年的经验，平均年龄为 45.0 岁。临床医生描述了家庭照顾者培训的循环过程，包括四个主要阶段：初步评估、教育、重新评估和调整。初步评估是非正式的和整体的；教育是通过示范和回授来提供的；重新评估用于评估照顾者的进展并为调整护理计划提供信息。临床医生指出，他们对家庭照顾者培训工作成功的看法影响了与临床实践相关的决策，包括提供的访问次数以及是否出院患者。
在家庭健康护理中，照顾者培训目前已整合到临床医生的工作流程中，并有助于确定访问强度和出院时间，但临床医生面临缺乏结构化评估工具或培训材料的问题。政策制定者和家庭健康机构为促进临床医生培训工作所做的努力可能会对医疗保险资助的家庭健康护理的成本和质量产生积极影响。
