Barber Tanya, Toon Lynn, Tandon Puneeta, Green Lee A
Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
Accelerating Change Transformations Team, Alberta Medical Association, Edmonton, Alberta, Canada.
Can Liver J. 2023 Feb 28;6(1):14-23. doi: 10.3138/canlivj-2022-0020. eCollection 2023 Feb.
Advanced cirrhosis results in frequent emergency department visits, hospital admissions and readmissions, and a high risk of premature death. We previously identified and compared differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions in care. The aim of this paper is to further explore how challenges to continuity and coordination of care influence how health care providers adapt in their approaches to and development of mental models of cirrhosis care. Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling took place over 6 months across Alberta for a total of 19 participants, made up of family physicians ( 8), specialists ( 9), and cirrhosis nurse practitioners ( 2). Lack of continuity in cirrhosis care, particularly informational and management continuity, not only hinders health care providers' ability to develop rich mental models of cirrhosis care but may also determine whether they form a patient-centred or task-based mental model, and whether they develop shared mental models with other providers. The system barriers and gaps that prevent the level of continuity needed to coordinate care for people with cirrhosis lead providers to create and work under mental models that perpetuate those barriers, in a vicious cycle. Understanding how providers approach cirrhosis care, adapt to the challenges facing them, and develop mental models offers insights into how to break that cycle and improve continuity and coordination.
晚期肝硬化导致患者频繁前往急诊科就诊、住院及再次住院，且过早死亡风险很高。我们之前识别并比较了初级保健医生、专科医生和执业护士对肝硬化护理的心智模式差异，这些差异可能是改善护理协调与过渡的切入点。本文旨在进一步探讨护理连续性和协调性方面的挑战如何影响医疗服务提供者在肝硬化护理心智模式的形成方法及发展过程中的适应方式。采用认知任务分析对心智模式进行横断面正式引出。通过目的抽样和链式推荐抽样，在艾伯塔省历时6个月共招募了19名参与者，包括家庭医生（8名）、专科医生（9名）和肝硬化执业护士（2名）。肝硬化护理缺乏连续性，尤其是信息连续性和管理连续性，不仅会阻碍医疗服务提供者形成丰富的肝硬化护理心智模式，还可能决定他们是形成以患者为中心还是基于任务的心智模式，以及是否与其他医疗服务提供者形成共享心智模式。妨碍为肝硬化患者协调护理所需连续性水平的系统障碍和差距，导致医疗服务提供者在持续存在这些障碍的心智模式下开展工作，形成恶性循环。了解医疗服务提供者如何开展肝硬化护理、如何应对面临的挑战以及如何形成心智模式，有助于深入了解如何打破这一循环，改善连续性和协调性。
