Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2022 May;70(5):1325-1335. doi: 10.1111/jgs.17762. Epub 2022 Mar 30.
During Medicare home health care (HHC), family caregiver assistance is often integral to implementing the care plan and avoiding readmission. Family caregiver training delivered by HHC clinicians (nurses and physical therapists [PTs]) helps ensure caregivers' ability to safely assist when HHC staff are not present. Yet, family caregiver training needs often go unmet during HHC, increasing the risk of adverse patient outcomes. There is a critical knowledge gap regarding challenges HHC clinicians face in providing necessary family caregiver training.
Multisite qualitative study using semi-structured, in-depth key informant interviews with Registered Nurses (n = 11) and PTs (n = 8) employed by four HHC agencies. Participating agencies were diverse in rurality, scale, ownership, and geographic region. Key informant interviews were audio-recorded, transcribed, and analyzed using directed content analysis to identify existing facilitators and barriers to family caregiver training during HHC.
Clinicians had an average of 9.3 years (range = 1.5-23 years) experience in HHC, an average age of 45.1 years (range = 28-63 years), and 95% were female. Clinicians identified facilitators and barriers to providing family caregiver training at the individual, interpersonal, and structural levels. The most salient factors included clinician-caregiver communication and rapport, accuracy of hospital discharge information, and access to resources such as additional visits and social work consultation. Clinicians noted the COVID-19 pandemic introduced additional challenges to providing family caregiver training, including caregivers' reduced access to hospital staff prior to discharge.
HHC clinicians identified a range of barriers and facilitators to delivering family caregiver training during HHC; particularly highlighting the role of clinician-caregiver communication. To support caregiver training in this setting, there is a need for updated reimbursement structures supporting greater visit flexibility, improved discharge communication between hospital and HHC, and structured communication aids to facilitate caregiver engagement and assessment.
在医疗保险家庭保健护理（HHC）期间，家庭护理员的协助通常是实施护理计划和避免再次入院的重要组成部分。HHC 临床医生（护士和物理治疗师[PT]）提供的家庭护理员培训有助于确保在 HHC 工作人员不在场时，护理员能够安全地协助。然而，在 HHC 期间，家庭护理员的培训需求经常得不到满足，增加了患者不良结局的风险。HHC 临床医生在提供必要的家庭护理员培训方面面临的挑战，这方面存在着关键的知识差距。
采用多地点定性研究方法，对四家 HHC 机构的注册护士（n=11）和物理治疗师（n=8）进行半结构化深入关键知情人访谈。参与的机构在农村性、规模、所有权和地理位置方面各不相同。对关键知情人访谈进行了录音、转录，并使用定向内容分析进行分析，以确定 HHC 期间家庭护理员培训的现有促进因素和障碍。
临床医生平均有 9.3 年（范围 1.5-23 年）的 HHC 经验，平均年龄为 45.1 岁（范围 28-63 岁），95%为女性。临床医生确定了在个人、人际和结构层面提供家庭护理员培训的促进因素和障碍。最突出的因素包括临床医生与护理员的沟通和融洽关系、医院出院信息的准确性，以及获得额外访问和社会工作咨询等资源的机会。临床医生指出，COVID-19 大流行给提供家庭护理员培训带来了额外的挑战，包括护理员在出院前减少了与医院工作人员的接触。
HHC 临床医生确定了在 HHC 期间提供家庭护理员培训的一系列障碍和促进因素；特别强调了临床医生与护理员沟通的作用。为了在这种环境下支持护理员培训，需要更新报销结构，支持更多访问灵活性，改善医院与 HHC 之间的出院沟通，并制定结构化的沟通工具，以促进护理员的参与和评估。
