Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Research Foundation - Flanders (FWO), Brussels, Belgium.
BMC Geriatr. 2022 May 2;22(1):386. doi: 10.1186/s12877-022-03051-1.
Geriatric co-management is advocated to manage frail patients in the hospital, but there is no guidance on how to implement such programmes in practice. This paper reports our experiences with implementing the 'Geriatric CO-mAnagement for Cardiology patients in the Hospital' (G-COACH) programme. We investigated if G-COACH was feasible to perform after the initial adoption, investigated how well the implementation strategy was able to achieve the implementation targets, determined how patients experienced receiving G-COACH, and determined how healthcare professionals experienced the implementation of G-COACH.
A feasibility study of the G-COACH programme was performed using a one-group experimental study design. G-COACH was previously implemented on two cardiac care units. Patients and healthcare professionals participating in the G-COACH programme were recruited for this evaluation. The feasibility of the programme was investigated by observing the reach, fidelity and dose using registrations in the electronic patient record and by interviewing patients. The success of the implementation reaching its targets was evaluated using a survey that was completed by 48 healthcare professionals. The experiences of 111 patients were recorded during structured survey interviews. The experiences of healthcare professionals with the implementation process was recorded during 6 semi-structured interviews and 4 focus groups discussions (n = 27).
The programme reached 91% in a sample of 151 patients with a mean age of 84 years. There was a high fidelity for the major components of the programme: documentation of geriatric risks (98%), co-management by specialist geriatrics nurse (95%), early rehabilitation (80%), and early discharge planning (74%), except for co-management by the geriatrician (32%). Both patients and healthcare professionals rated G-COACH as acceptable (95 and 94%) and feasible (96 and 74%). The healthcare professionals experienced staffing, competing roles and tasks of the geriatrics nurse and leadership support as important determinants for implementation.
The implementation strategy resulted in the successful initiation of the G-COACH programme. G-COACH was perceived as acceptable and feasible. Fidelity was influenced by context factors. Further investigation of the sustainability of the programme is needed.
ISRCTN22096382 (21/05/2020).
老年共管理被提倡用于管理医院中的虚弱患者，但在实践中，没有关于如何实施此类计划的指导。本文报告了我们在实施“老年共管理心脏病患者（G-COACH）”计划方面的经验。我们调查了 G-COACH 在最初采用后是否可行，调查了实施策略在实现实施目标方面的表现如何，确定了患者接受 G-COACH 的体验如何，以及医疗保健专业人员在实施 G-COACH 方面的体验如何。
采用单组实验研究设计对 G-COACH 计划进行可行性研究。G-COACH 此前已在两个心脏护理病房实施。参与 G-COACH 计划的患者和医疗保健专业人员被招募进行此评估。通过观察电子病历中的注册信息来评估计划的可行性，包括可达性、保真度和剂量，还通过访谈患者来评估计划的可行性。通过由 48 名医疗保健专业人员完成的调查评估实施的成功程度，该调查评估了实施达到目标的情况。记录了 111 名患者在结构化调查访谈中的体验。通过 6 次半结构访谈和 4 次焦点小组讨论（n=27）记录了医疗保健专业人员对实施过程的体验。
在 151 名平均年龄为 84 岁的患者样本中，该计划的可达性为 91%。该计划的主要组成部分具有很高的保真度：老年风险的记录（98%）、专科老年护士的共同管理（95%）、早期康复（80%）和早期出院计划（74%），但老年医生的共同管理（32%）除外。患者和医疗保健专业人员均将 G-COACH 评为可接受（95%和 94%）和可行（96%和 74%）。医疗保健专业人员认为人员配备、老年护士的角色和任务以及领导支持是实施的重要决定因素。
实施策略导致 G-COACH 计划的成功启动。G-COACH 被认为是可接受和可行的。保真度受到背景因素的影响。需要进一步调查该计划的可持续性。
ISRCTN22096382（21/05/2020）。
