Amsterdam University Medical Centre, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
ACHIEVE- Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands.
Age Ageing. 2023 Jan 8;52(1). doi: 10.1093/ageing/afac206.
there is a trend across Europe to enable more care at the community level. The Acute Geriatric Community Hospital (AGCH) in the Netherlands in an acute geriatric unit situated in a skilled nursing facility (SNF). It provides hospital-level care for older adults with acute medical conditions. The aim of this study is to identify barriers and facilitators associated with implementing the AGCH in a SNF.
semi-structured interviews (n = 42) were carried out with clinical and administrative personnel at the AGCH and university hospital and stakeholders from the partnering care organisations and health insurance company. Data were analysed using thematic analysis.
facilitators to implementing the AGCH concept were enthusiasm for the AGCH concept, organising preparatory sessions, starting with low-complex patients, good team leadership and ongoing education of the AGCH team. Other facilitators included strong collaboration between stakeholders, commitment to shared investment costs and involvement of regulators.Barriers to implementation were providing hospital care in an SNF, financing AGCH care, difficulties selecting patients at the emergency department, lack of protocols and guidelines, electronic health records unsuited for hospital care, department layout on two different floors and complex shared business operations. Furthermore, transfer of acute care to the community care meant that some care was not reimbursed.
the AGCH concept was valued by all stakeholders. The main facilitators included the perceived value of the AGCH concept and enthusiasm of stakeholders. Structural financing is an obstacle to the expansion and continuation of this care model.
欧洲有一个趋势，就是在社区层面提供更多的护理。荷兰的急性老年社区医院（AGCH）是一家位于熟练护理设施（SNF）中的急性老年病房，为患有急性内科疾病的老年人提供医院级别的护理。本研究的目的是确定在 SNF 中实施 AGCH 的障碍和促进因素。
对 AGCH 和大学医院的临床和行政人员以及来自合作护理组织和健康保险公司的利益相关者进行了半结构式访谈（n=42）。使用主题分析对数据进行分析。
实施 AGCH 概念的促进因素包括对 AGCH 概念的热情、组织预备会议、从低复杂度患者开始、良好的团队领导和对 AGCH 团队的持续教育。其他促进因素包括利益相关者之间的紧密合作、对共同投资成本的承诺以及监管机构的参与。实施的障碍包括在 SNF 提供医院护理、AGCH 护理的融资、在急诊科选择患者的困难、缺乏协议和指南、不适合医院护理的电子病历、两个不同楼层的科室布局以及复杂的共享业务运营。此外，将急性护理转移到社区护理意味着一些护理得不到报销。
所有利益相关者都对 AGCH 概念给予了高度评价。主要的促进因素包括对 AGCH 概念的感知价值和利益相关者的热情。结构性融资是扩大和延续这种护理模式的障碍。
