OpenLab, University Health Network, Toronto, Ontario, Canada
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Qual. 2021 Oct;10(4). doi: 10.1136/bmjoq-2021-001540.
High-risk patients account for a disproportionate amount of healthcare use, necessitating the development of care delivery solutions aimed specifically at reducing this use. These interventions have largely been unsuccessful, perhaps due to a lack of attention to patients' social needs and engagement of patients in developing solutions.
The project team used a combination of administrative data, information culled from charts and interviews with high-risk patients to understand social needs, the current experience of addressing social needs in the hospital, and patient preferences and identified opportunities for improvement. Interviews were conducted in March and April 2020, and patients were asked to reflect on their experiences both before and during the COVID-19 pandemic.
A total of 4579 patients with 26 168 visits to the emergency department and 2904 inpatient admissions in the previous year were identified. Qualitative analysis resulted in three themes: (1) the interaction between social needs, demographics, and health; (2) the hospital's role in addressing social needs; and (3) the impact of social needs on experiences of care. Themes related to experiences before and during COVID-19 did not differ. Three opportunities were identified: (1) training for staff related to stigma and trauma, (2) improved documentation of social needs and (3) creation of navigation programmes.
Certain demographic factors were clearly associated with an increased need for social support. Unfortunately, many factors identified by patients as mediating their need for such support were not consistently captured. Going forward, high-risk patients should be included in the development of quality improvement initiatives and programmes to address social needs.
高风险患者在医疗保健使用中所占比例不成比例，因此需要开发专门针对减少这种使用的医疗服务解决方案。这些干预措施在很大程度上都没有成功，也许是因为没有关注患者的社会需求，也没有让患者参与到解决方案的制定中来。
项目团队结合了行政数据、从图表中收集的信息以及对高风险患者的访谈，以了解社会需求、医院目前在解决社会需求方面的经验以及患者的偏好，并确定了改进的机会。访谈于 2020 年 3 月和 4 月进行，患者被要求反思他们在 COVID-19 大流行之前和期间的经验。
共确定了 4579 名患者，他们在过去一年中有 26168 次急诊就诊和 2904 次住院治疗。定性分析产生了三个主题：（1）社会需求、人口统计学和健康之间的相互作用；（2）医院在解决社会需求方面的作用；（3）社会需求对护理体验的影响。与 COVID-19 之前和期间相关的主题没有差异。确定了三个机会：（1）与污名和创伤相关的员工培训；（2）改善社会需求的记录；（3）创建导航方案。
某些人口统计学因素显然与对社会支持的需求增加有关。不幸的是，许多患者认为是影响他们对这种支持的需求的因素并没有得到一致的记录。今后，高风险患者应参与制定质量改进计划和方案，以解决社会需求。
